1841437035 NPI number — MRS. MARISEL TRAVERZO LMSW

Table of content: MRS. MARISEL TRAVERZO LMSW (NPI 1841437035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841437035 NPI number — MRS. MARISEL TRAVERZO LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAVERZO
Provider First Name:
MARISEL
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRAVERZO-HILAIRE
Provider Other First Name:
MARISEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841437035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14110 82ND DR
Provider Second Line Business Mailing Address:
APT 335
Provider Business Mailing Address City Name:
BRIARWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11435-1134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-847-5116
Provider Business Mailing Address Fax Number:
718-847-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14110 82ND DR
Provider Second Line Business Practice Location Address:
APT 335
Provider Business Practice Location Address City Name:
BRIARWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11435-1134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-847-5116
Provider Business Practice Location Address Fax Number:
718-847-5116
Provider Enumeration Date:
01/10/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  061886-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)