Provider Demographics
NPI:1841437035
Name:TRAVERZO, MARISEL (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARISEL
Middle Name:
Last Name:TRAVERZO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:MARISEL
Other - Middle Name:
Other - Last Name:TRAVERZO-HILAIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:14110 82ND DR
Mailing Address - Street 2:APT 335
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1134
Mailing Address - Country:US
Mailing Address - Phone:718-847-5116
Mailing Address - Fax:718-847-5116
Practice Address - Street 1:14110 82ND DR
Practice Address - Street 2:APT 335
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1134
Practice Address - Country:US
Practice Address - Phone:718-847-5116
Practice Address - Fax:718-847-5116
Is Sole Proprietor?:No
Enumeration Date:2009-01-10
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061886-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker