Provider Demographics
NPI:1376732289
Name:MIRISOLA, MARCI ANN (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARCI
Middle Name:ANN
Last Name:MIRISOLA
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 OAK ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2841
Mailing Address - Country:US
Mailing Address - Phone:631-317-1775
Mailing Address - Fax:
Practice Address - Street 1:31 OAK ST
Practice Address - Street 2:SUITE 7
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2841
Practice Address - Country:US
Practice Address - Phone:631-317-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006208101YM0800X
WARC 00041494390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health