Provider Demographics
NPI:1306715131
Name:RUSSELL, MARISSA (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:HUGUENOT
Mailing Address - State:NY
Mailing Address - Zip Code:12746-5218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 PARAGON DR
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1791
Practice Address - Country:US
Practice Address - Phone:845-747-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst