Provider Demographics
NPI:1588115679
Name:POMARICO-MAXSON, MARISSA ANNE
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANNE
Last Name:POMARICO-MAXSON
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 1:19 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1209
Mailing Address - Country:US
Mailing Address - Phone:607-267-1055
Mailing Address - Fax:
Practice Address - Street 1:242 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2527
Practice Address - Country:US
Practice Address - Phone:607-431-1030
Practice Address - Fax:607-431-1033
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)