Provider Demographics
NPI:1871125526
Name:MARRA, MARISSA VICTORIA (LPC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:VICTORIA
Last Name:MARRA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DOWD AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2480
Mailing Address - Country:US
Mailing Address - Phone:860-412-4638
Mailing Address - Fax:
Practice Address - Street 1:111 MAIN ST # 2WA
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06019-3182
Practice Address - Country:US
Practice Address - Phone:860-412-4638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health