Provider Demographics
NPI:1417104225
Name:FELDMAN, MARISSA ALEXIS
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ALEXIS
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 6TH STREET SOUTH
Mailing Address - Street 2:SUITE 420
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-767-8477
Mailing Address - Fax:727-767-8244
Practice Address - Street 1:880 6TH ST S STE 420
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4825
Practice Address - Country:US
Practice Address - Phone:727-767-8477
Practice Address - Fax:727-767-8244
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9912103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical