| Marisa P Distefano Lpc Llc | |
|
172 Franklin Ave Ste 4b Ridgewood NJ 07450-3229 | |
| (201) 446-4669 | |
| Not Available |
| Full Name | Marisa P Distefano Lpc Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 172 Franklin Ave Ste 4b, Ridgewood, New Jersey |
| Authorized Official Name and Position | Marisa Distefano (OWNER) |
| Authorized Official Contact | 2014464669 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marisa P Distefano Lpc Llc 172 Franklin Ave Ste 4b Ridgewood NJ 07450-3229 Ph: (201) 446-4669 | Marisa P Distefano Lpc Llc 172 Franklin Ave Ste 4b Ridgewood NJ 07450-3229 Ph: (201) 446-4669 |
| NPI Number | 1194532861 |
|---|---|
| Provider Enumeration Date | 12/16/2024 |
| Last Update Date | 12/27/2024 |
| Certification Date | 12/27/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194532861 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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