Provider Demographics
NPI:1386268407
Name:MASLEN, MARISA MICHELLE
Entity type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:MICHELLE
Last Name:MASLEN
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 1:68 MAXIM DR
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1459
Mailing Address - Country:US
Mailing Address - Phone:908-910-4790
Mailing Address - Fax:
Practice Address - Street 1:1 LUPTON AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-5901
Practice Address - Country:US
Practice Address - Phone:856-332-4698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst