Provider Demographics
NPI:1669740965
Name:COLERIDGE, MARISSA B (MS, CGC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:B
Last Name:COLERIDGE
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-218-2842
Mailing Address - Fax:216-445-6935
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:NE50
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-8088
Practice Address - Fax:216-445-6935
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS