Provider Demographics
NPI:1578817524
Name:MARRACCINI, LISA LOUISE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LOUISE
Last Name:MARRACCINI
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:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:NV
Mailing Address - Zip Code:89429-0330
Mailing Address - Country:US
Mailing Address - Phone:775-577-4200
Mailing Address - Fax:775-577-3338
Practice Address - Street 1:3550 GRAHAM AVENUE
Practice Address - Street 2:
Practice Address - City:SILVER SPRINGS
Practice Address - State:NV
Practice Address - Zip Code:89429
Practice Address - Country:US
Practice Address - Phone:775-577-4200
Practice Address - Fax:775-577-3338
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor