Provider Demographics
NPI:1114573797
Name:FELDER, MARISSA (LMHC, NCC, CIMHP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:FELDER
Suffix:
Gender:F
Credentials:LMHC, NCC, CIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BROADWAY STE 3
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2797
Mailing Address - Country:US
Mailing Address - Phone:631-640-2088
Mailing Address - Fax:631-448-3809
Practice Address - Street 1:116 BROADWAY STE 3
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2797
Practice Address - Country:US
Practice Address - Phone:631-640-2088
Practice Address - Fax:631-448-3809
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-10
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty