Provider Demographics
NPI:1699343194
Name:FALLONE, MARISA (DO)
Entity type:Individual
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First Name:MARISA
Middle Name:
Last Name:FALLONE
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Gender:F
Credentials:DO
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:STE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:TRINITY HEALTH ACADEMIC PSYCHIATRY & COUNSELING
Practice Address - Street 2:19000 ST JOES PARKWAY SUITE 310
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-743-4540
Practice Address - Fax:734-743-4541
Is Sole Proprietor?:No
Enumeration Date:2021-06-12
Last Update Date:2025-05-28
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Provider Licenses
StateLicense IDTaxonomies
MI51010285542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry