Provider Demographics
NPI:1003171547
Name:MANNETTA, MARISSA JANENE (LMHC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:JANENE
Last Name:MANNETTA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7635 ASHLEY PARK CT STE 503H
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6197
Mailing Address - Country:US
Mailing Address - Phone:407-963-4733
Mailing Address - Fax:407-215-9436
Practice Address - Street 1:7635 ASHLEY PARK CT STE 503H
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6197
Practice Address - Country:US
Practice Address - Phone:407-963-4733
Practice Address - Fax:407-215-9436
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17360101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health