Provider Demographics
NPI:1376181362
Name:MOSER, MARISSA J (LMHC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:J
Last Name:MOSER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:J
Other - Last Name:ROSINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:500 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2449
Mailing Address - Country:US
Mailing Address - Phone:516-341-0097
Mailing Address - Fax:
Practice Address - Street 1:500 MERRICK RD
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2449
Practice Address - Country:US
Practice Address - Phone:516-341-0097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health