Provider Demographics
NPI:1851136113
Name:VESCIO, MARISA
Entity type:Individual
Prefix:MS
First Name:MARISA
Middle Name:
Last Name:VESCIO
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 1:4 COLONIAL DR APT A
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1825
Mailing Address - Country:US
Mailing Address - Phone:862-823-5608
Mailing Address - Fax:
Practice Address - Street 1:4 COLONIAL DR APT A
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1825
Practice Address - Country:US
Practice Address - Phone:862-823-5608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060194001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical