Provider Demographics
NPI:1215476130
Name:FERNANDEZ, MARISSA (LPC)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2341
Mailing Address - Country:US
Mailing Address - Phone:908-247-9491
Mailing Address - Fax:
Practice Address - Street 1:722 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2341
Practice Address - Country:US
Practice Address - Phone:908-247-9491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC0057330101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health