Provider Demographics
NPI:1972247435
Name:BONAMASSA-CIMINO, MARISA CHRISTINE (LAC)
Entity Type:Individual
Prefix:MISS
First Name:MARISA
Middle Name:CHRISTINE
Last Name:BONAMASSA-CIMINO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 B ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2543
Mailing Address - Country:US
Mailing Address - Phone:732-320-2570
Mailing Address - Fax:
Practice Address - Street 1:445 BRICK BLVD STE 304
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6080
Practice Address - Country:US
Practice Address - Phone:732-814-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00637000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor