Provider Demographics
NPI:1134476278
Name:DEVITA, MARISSA FRANCES (MA, ATR-BC, LPC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:FRANCES
Last Name:DEVITA
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 KNIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-4242
Mailing Address - Country:US
Mailing Address - Phone:215-637-2077
Mailing Address - Fax:215-637-2079
Practice Address - Street 1:10700 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-4242
Practice Address - Country:US
Practice Address - Phone:215-637-2077
Practice Address - Fax:215-637-2079
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional