Provider Demographics
NPI:1003700139
Name:MERINO, MARISSA EDEN (MFT, LIFE COACH)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:EDEN
Last Name:MERINO
Suffix:
Gender:F
Credentials:MFT, LIFE COACH
Other - Prefix:MS
Other - First Name:MARISSA
Other - Middle Name:EDEN
Other - Last Name:TICKTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1207 KLOCKNER RD APT 46
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3620
Mailing Address - Country:US
Mailing Address - Phone:609-649-0844
Mailing Address - Fax:
Practice Address - Street 1:691 US HIGHWAY 130 STE 5
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-2207
Practice Address - Country:US
Practice Address - Phone:609-806-5083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00872100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist