Provider Demographics
NPI:1396843843
Name:LOSASSO, MARIETTE (MSN, CS, RN)
Entity Type:Individual
Prefix:
First Name:MARIETTE
Middle Name:
Last Name:LOSASSO
Suffix:
Gender:F
Credentials:MSN, CS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 8TH STREET
Mailing Address - Street 2:SUITE 304A
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906
Mailing Address - Country:US
Mailing Address - Phone:719-635-7811
Mailing Address - Fax:719-630-7858
Practice Address - Street 1:1301 8TH STREET
Practice Address - Street 2:SUITE 304A
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906
Practice Address - Country:US
Practice Address - Phone:719-635-7811
Practice Address - Fax:719-630-7858
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor