Provider Demographics
NPI:1447285945
Name:KOTEN, MARISA PISANI (PHD)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:PISANI
Last Name:KOTEN
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 1:207 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6302
Mailing Address - Country:US
Mailing Address - Phone:212-779-2277
Mailing Address - Fax:212-779-2444
Practice Address - Street 1:99 UNIVERSITY PL
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4528
Practice Address - Country:US
Practice Address - Phone:212-252-2487
Practice Address - Fax:212-779-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015003103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM7211Medicare ID - Type UnspecifiedUPIN/MEDICARE#