Provider Demographics
NPI:1396639951
Name:CHELI, MARISSA R (MS, ADCI)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:R
Last Name:CHELI
Suffix:
Gender:F
Credentials:MS, ADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 MARYLAND RD
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2415
Mailing Address - Country:US
Mailing Address - Phone:908-922-5314
Mailing Address - Fax:
Practice Address - Street 1:603 MARYLAND RD
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2415
Practice Address - Country:US
Practice Address - Phone:908-922-5314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2024-000362101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)