Provider Demographics
NPI:1063748424
Name:MASUCCI-MARTORELLA, MARIALEEN (LCSW-R,BCD)
Entity type:Individual
Prefix:
First Name:MARIALEEN
Middle Name:
Last Name:MASUCCI-MARTORELLA
Suffix:
Gender:F
Credentials:LCSW-R,BCD
Other - Prefix:
Other - First Name:MARIALEEN
Other - Middle Name:
Other - Last Name:MARTORELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R, BCD
Mailing Address - Street 1:33 WILLA WAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-8528
Mailing Address - Country:US
Mailing Address - Phone:917-939-7056
Mailing Address - Fax:
Practice Address - Street 1:5254 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6206
Practice Address - Country:US
Practice Address - Phone:917-939-7056
Practice Address - Fax:917-939-7056
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
NY076652-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical