Marisa Boulukos, LCSWR

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R042317-1 Issued in NY

Practice address

75 Grand Ave
Massapequa, NY 11758-4905

Phone

(516) 799-3202

NPI assigned

Jan 22, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437203320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 CRESCENT COVE CT",
            "city": "SEAFORD",
            "state": "NY",
            "postal_code": "117833649",
            "telephone_number": "561-781-9540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 GRAND AVE",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117584905",
            "telephone_number": "516-799-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULUKOS",
        "first_name": "MARISA",
        "name_prefix": "Mrs.",
        "credential": "LCSWR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R042317-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Todd M Bornfriend, PT
• Stephen John Borrelli, PHARMD., RPH
• Monica Bottari, MSOT, OTR/L
• Carol Anne Bottiglieri
• Chris Boukas, RN
• Ruth Bouzy
• Jaime Bowen, LMSW
• Andrea Boyle, CCC-SLP
• Sarah Boyle
• Shantell Bradley

• Clinical Social Worker in Massapequa, NY
• Providers in Massapequa, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.