Provider Demographics
NPI:1952664666
Name:SKINNER, MARISSA E (MS ED)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:E
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-5324
Mailing Address - Country:US
Mailing Address - Phone:518-274-2607
Mailing Address - Fax:
Practice Address - Street 1:50 PHILIP ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-1413
Practice Address - Country:US
Practice Address - Phone:518-434-0815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist