Provider Demographics
NPI:1093283871
Name:CARAMELLO, MARISSA REBECCA (BA, CRT, C-SLPA)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:REBECCA
Last Name:CARAMELLO
Suffix:
Gender:F
Credentials:BA, CRT, C-SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RANDALL SQ STE 302
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2773
Mailing Address - Country:US
Mailing Address - Phone:401-443-5252
Mailing Address - Fax:401-633-7163
Practice Address - Street 1:1 RANDALL SQ STE 302
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2773
Practice Address - Country:US
Practice Address - Phone:401-443-5252
Practice Address - Fax:401-633-7163
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355S0801X
RIRCP01562227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant