Provider Demographics
NPI:1114592698
Name:BROWNSTEIN, MARISA ALLISON
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:ALLISON
Last Name:BROWNSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CORRINE ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1838
Mailing Address - Country:US
Mailing Address - Phone:732-956-1596
Mailing Address - Fax:
Practice Address - Street 1:3 CORRINE ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1838
Practice Address - Country:US
Practice Address - Phone:732-956-1596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician