Provider Demographics
NPI:1639368616
Name:ZUCARELLI, MARISA L (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:L
Last Name:ZUCARELLI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:MARISA
Other - Middle Name:L
Other - Last Name:PANDOLFO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:118 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2662
Mailing Address - Country:US
Mailing Address - Phone:508-747-0402
Mailing Address - Fax:508-747-1511
Practice Address - Street 1:118 LONG POND RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2662
Practice Address - Country:US
Practice Address - Phone:508-747-0402
Practice Address - Fax:508-747-1511
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2155356101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool