1972864791 NPI number — MRS. MARISA E BEHARRY MS. ED.

Table of content: MRS. MARISA E BEHARRY MS. ED. (NPI 1972864791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972864791 NPI number — MRS. MARISA E BEHARRY MS. ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEHARRY
Provider First Name:
MARISA
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS. ED.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEHARRY
Provider Other First Name:
MARISA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS ED..
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1972864791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 CLINTON AVE APT 4G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11238-1170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-406-3402
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 CLINTON AVE .
Provider Second Line Business Practice Location Address:
4G
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-406-3402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2012

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: 171W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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