Provider Demographics
NPI:1205148814
Name:MARCHESE-MAZZEO, MARIA NICOLE (PSYD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:NICOLE
Last Name:MARCHESE-MAZZEO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HARBOR BLVD
Mailing Address - Street 2:UNIT # 925
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-6746
Mailing Address - Country:US
Mailing Address - Phone:201-647-4578
Mailing Address - Fax:201-865-3867
Practice Address - Street 1:2002 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4431
Practice Address - Country:US
Practice Address - Phone:201-647-4578
Practice Address - Fax:201-865-3867
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6300103T00000X
NY016414103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist