MEDICARE: MICHELLE CARISSIMI M.S.ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	1637607	NY

General Provider Information

NPI Number	:	1942621941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE CARISSIMI M.S.ED

Provider Business Mailing Address
First Line	:	1464 76TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2408
Country	:	US
Telephone Number	:	347-782-3257
Fax Number	:	718-443-3499

Provider Business Practice Location Address
First Line	:	1464 76TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2408
Country	:	US
Telephone Number	:	347-782-3257
Fax Number	:	718-443-3499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	02/18/2014

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Directions to “ MICHELLE CARISSIMI M.S.ED” Practice Location

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