Provider Demographics
NPI:1972355246
Name:UHER, MARISSA MARIE (ATR-BC, LPC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:MARIE
Last Name:UHER
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 POTTERS PL
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2679
Mailing Address - Country:US
Mailing Address - Phone:267-949-7111
Mailing Address - Fax:
Practice Address - Street 1:1031 OLD CASSATT RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1152
Practice Address - Country:US
Practice Address - Phone:267-297-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA23-065221700000X
PAPC016739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist