Provider Demographics
NPI:1679294243
Name:NUNEZ, MARISA RODRIGO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:RODRIGO
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 FAIRLAWN DR
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-1121
Mailing Address - Country:US
Mailing Address - Phone:215-378-2941
Mailing Address - Fax:
Practice Address - Street 1:239 MADISON AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1948
Practice Address - Country:US
Practice Address - Phone:201-669-1369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00662000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist