Provider Demographics
NPI:1114742418
Name:MARISTCH, MARINA (PMHNP)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:MARISTCH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 ROUTE 70 E BLDG A-101
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2341
Mailing Address - Country:US
Mailing Address - Phone:856-446-4728
Mailing Address - Fax:856-230-7229
Practice Address - Street 1:771 ROUTE 70 E STE D100
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2356
Practice Address - Country:US
Practice Address - Phone:856-446-4728
Practice Address - Fax:856-230-7229
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15217000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty