Provider Demographics
NPI:1114652732
Name:DILEO, MARISA (MA, LAC)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:DILEO
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2065
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-5065
Mailing Address - Country:US
Mailing Address - Phone:856-685-8627
Mailing Address - Fax:
Practice Address - Street 1:1260 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-2412
Practice Address - Country:US
Practice Address - Phone:856-499-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00651200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health