Provider Demographics
NPI:1871003962
Name:ROECKLEIN, MARISSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:ROECKLEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:SNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:8102 SILVER PALM CT
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2728
Mailing Address - Country:US
Mailing Address - Phone:845-598-3583
Mailing Address - Fax:
Practice Address - Street 1:4851 W HILLSBORO BLVD STE A1
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4355
Practice Address - Country:US
Practice Address - Phone:561-558-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical