Provider Demographics
NPI:1386392611
Name:ROSS, MARISSA (MA, EDS, LAC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA, EDS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 AMERMAN LN
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-5141
Mailing Address - Country:US
Mailing Address - Phone:908-655-8441
Mailing Address - Fax:
Practice Address - Street 1:75 N MAPLE AVE STE 101B
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3261
Practice Address - Country:US
Practice Address - Phone:551-250-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health