Provider Demographics
NPI:1366850422
Name:SALA, MARISSA (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:SALA
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 28TH AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4903
Mailing Address - Country:US
Mailing Address - Phone:631-278-1160
Mailing Address - Fax:
Practice Address - Street 1:3404 28TH AVE APT 2R
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4903
Practice Address - Country:US
Practice Address - Phone:631-278-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066997101YM0800X
NY006997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty