Provider Demographics
NPI:1376421925
Name:PETERSON, MARISA (LPC)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 VIENNA HILLS RD
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-4912
Mailing Address - Country:US
Mailing Address - Phone:973-900-3507
Mailing Address - Fax:973-900-3507
Practice Address - Street 1:19 VIENNA HILLS RD
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4912
Practice Address - Country:US
Practice Address - Phone:973-900-3507
Practice Address - Fax:973-900-3507
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01126200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional