Provider Demographics
NPI:1639826464
Name:CASAMENTO, MARISSA MAKENZIE
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:MAKENZIE
Last Name:CASAMENTO
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 1:10921 MCKINLEY DR # 17302
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6455
Mailing Address - Country:US
Mailing Address - Phone:239-281-6539
Mailing Address - Fax:
Practice Address - Street 1:11602 N 51ST ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-2132
Practice Address - Country:US
Practice Address - Phone:813-438-5391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst