Individual
MARIE ANNE MANCUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
20514 LINDEN BLVD, SUITE 204, SAINT ALBANS, NY 11412-2900
(718) 528-5493
Mailing address
128 E 3RD ST, BROOKLYN, NY 11218-1406
(347) 756-9400
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
659896
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402366
NY
Other
Enumeration date
02/28/2013
Last updated
01/09/2019
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