Healthcare Provider Details

I. General information

NPI: 1932826039
Provider Name (Legal Business Name): MARISSA PERSICO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MAIN ST FL 5
NEW BRITAIN CT
06051-4206
US

IV. Provider business mailing address

233 MAIN ST FL 5
NEW BRITAIN CT
06051-4206
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-8192
  • Fax:
Mailing address:
  • Phone: 860-224-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7302
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: