Provider Demographics
NPI:1386944114
Name:BURNS, MARISSA CHRISTINE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:CHRISTINE
Last Name:BURNS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:CHRISTINE
Other - Last Name:ZERCIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 840
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:NY
Mailing Address - Zip Code:12742
Mailing Address - Country:US
Mailing Address - Phone:845-794-1400
Mailing Address - Fax:845-707-8857
Practice Address - Street 1:641 OLD ROUTE 17
Practice Address - Street 2:
Practice Address - City:HARRIS
Practice Address - State:NY
Practice Address - Zip Code:12742
Practice Address - Country:US
Practice Address - Phone:845-794-1400
Practice Address - Fax:845-707-8857
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020529-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist