Provider Demographics
NPI:1780894535
Name:TOMASIC, MARISA M
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:M
Last Name:TOMASIC
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARISA
Other - Middle Name:M
Other - Last Name:TOMASIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:612 HIGHLAND PL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202-2930
Mailing Address - Country:US
Mailing Address - Phone:412-761-5967
Mailing Address - Fax:412-766-0953
Practice Address - Street 1:5000 MCKNIGHT RD
Practice Address - Street 2:SUITE 207
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3420
Practice Address - Country:US
Practice Address - Phone:412-367-1481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-OO8358-L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling