Provider Demographics
NPI:1255913109
Name:ROSS, MARISSA (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 FAIRVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-1309
Mailing Address - Country:US
Mailing Address - Phone:603-860-6310
Mailing Address - Fax:
Practice Address - Street 1:1 EMERSON PL STE 3H
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2252
Practice Address - Country:US
Practice Address - Phone:617-397-3951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH070155-23363LP0808X
MARN2293349363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health