Provider Demographics
NPI:1568146041
Name:GRAY, MARISSA NICOLE (BA, RBT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:NICOLE
Last Name:GRAY
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:NICOLE
Other - Last Name:SALZMAN-KEMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 GREAT VALLEY PKWY STE 270
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1426
Mailing Address - Country:US
Mailing Address - Phone:484-757-5538
Mailing Address - Fax:610-889-9726
Practice Address - Street 1:5 GREAT VALLEY PKWY STE 270
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1426
Practice Address - Country:US
Practice Address - Phone:484-757-5538
Practice Address - Fax:610-889-9726
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician