Organization
DAVID L MARASCIULLO PH.D,PSYCHOLOGIST, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID LOUIS MARASCIULLO PHD (CLINICAL DIRECTOR)
(631) 643-7390
Entity
Organization
Contact information
Practice address
18 S HOLLOW RD, DIX HILLS, NY 11746-6140
(631) 643-7390
(631) 643-5068
Mailing address
18 S HOLLOW RD, DIX HILLS, NY 11746-6140
(631) 643-7390
(631) 643-5068
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3879
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02927659
—
NY
01
—
3879
PSYCHOLOGY LICENSE
NY
01
—
S0879-4 B
WORKERS' COMPENSATION
NY
Enumeration date
03/28/2007
Last updated
05/25/2011
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