Provider Demographics
NPI:1598425985
Name:MRISO, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MRISO
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 1:6028 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15007-9720
Mailing Address - Country:US
Mailing Address - Phone:724-882-3980
Mailing Address - Fax:
Practice Address - Street 1:30 GLADE RUN DR
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-2200
Practice Address - Country:US
Practice Address - Phone:724-452-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional