Provider Demographics
NPI:1841999067
Name:DENNIS, MARISSA (MA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W SPRINGFIELD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3440
Mailing Address - Country:US
Mailing Address - Phone:802-760-7673
Mailing Address - Fax:
Practice Address - Street 1:202 W SPRINGFIELD ST APT 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3440
Practice Address - Country:US
Practice Address - Phone:802-760-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty