Provider Demographics
NPI:1912708835
Name:MELCHIORRE, MARISA DAREMA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:DAREMA
Last Name:MELCHIORRE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 WILLOWBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1640
Mailing Address - Country:US
Mailing Address - Phone:609-230-0902
Mailing Address - Fax:
Practice Address - Street 1:88 S LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1229
Practice Address - Country:US
Practice Address - Phone:856-484-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01296100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist