Provider Demographics
NPI:1245657071
Name:GELFAND, MARISA (MED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:GELFAND
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:JAFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7710 CARONDELET AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3319
Mailing Address - Country:US
Mailing Address - Phone:978-273-5737
Mailing Address - Fax:
Practice Address - Street 1:7710 CARONDELET AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3319
Practice Address - Country:US
Practice Address - Phone:978-273-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013030600101YP2500X
VA0701005319101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional