Provider Demographics
NPI:1346454279
Name:MARISAK, KAREN (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:MARISAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W 86TH ST
Mailing Address - Street 2:SUITE 1AA
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3604
Mailing Address - Country:US
Mailing Address - Phone:212-874-6487
Mailing Address - Fax:212-866-7737
Practice Address - Street 1:20 W 86TH ST
Practice Address - Street 2:SUITE 1AA
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3604
Practice Address - Country:US
Practice Address - Phone:212-874-6487
Practice Address - Fax:212-866-7737
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006694103T00000X, 103TA0400X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP590762OtherOXFORD PROVIDER ID
NY01459828Medicaid
NYV48121Medicare ID - Type Unspecified