Provider Demographics
NPI:1962241018
Name:ROMANO, MARISSA (LCMHCA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:ROMANO
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-4249
Mailing Address - Country:US
Mailing Address - Phone:201-696-6014
Mailing Address - Fax:
Practice Address - Street 1:780 NW BROAD ST # 310
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4102
Practice Address - Country:US
Practice Address - Phone:833-846-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty