Provider Demographics
NPI:1154749679
Name:DECHIARO, MARISA (MA)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:DECHIARO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 GARTH RD APT 5E
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-8004
Mailing Address - Country:US
Mailing Address - Phone:845-807-7031
Mailing Address - Fax:
Practice Address - Street 1:209 GARTH RD APT 5E
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-8004
Practice Address - Country:US
Practice Address - Phone:845-807-7031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY000762103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist