Provider Demographics
NPI:1780153866
Name:RAMIREZ, MARISSA BEATRIZ
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:BEATRIZ
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 PURE BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-4651
Mailing Address - Country:US
Mailing Address - Phone:813-540-2532
Mailing Address - Fax:512-339-2239
Practice Address - Street 1:3211 VINELAND RD # 289
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4907
Practice Address - Country:US
Practice Address - Phone:813-540-2532
Practice Address - Fax:512-339-2239
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-18
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH13751101YM0800X
FLMH19163101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health