Provider Demographics
NPI:1578061495
Name:BLANKSTEIN, MARISSA
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:BLANKSTEIN
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 1:18370 LIMESTONE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3860
Mailing Address - Country:US
Mailing Address - Phone:561-598-6200
Mailing Address - Fax:
Practice Address - Street 1:18370 LIMESTONE CREEK RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3860
Practice Address - Country:US
Practice Address - Phone:561-598-6200
Practice Address - Fax:561-320-9495
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-17-28714103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst