Provider Demographics
NPI:1427713833
Name:MARISSA ROMANOVITCH, PLLC
Entity type:Organization
Organization Name:MARISSA ROMANOVITCH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:PLANTE
Authorized Official - Last Name:ROMANOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-324-5029
Mailing Address - Street 1:835 CENTRAL AVE STE 126
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2506
Mailing Address - Country:US
Mailing Address - Phone:413-324-5029
Mailing Address - Fax:
Practice Address - Street 1:835 CENTRAL AVE STE 126
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2506
Practice Address - Country:US
Practice Address - Phone:413-324-5029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health