Healthcare Provider Details

I. General information

NPI: 1447921382
Provider Name (Legal Business Name): CHRISTINE MARSICO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 BOYLSTON ST FL 5 SUITE 1717
BOSTON MA
02116
US

IV. Provider business mailing address

42 JACKSON ST
CONCORD NH
03301-4566
US

V. Phone/Fax

Practice location:
  • Phone: 617-221-3202
  • Fax:
Mailing address:
  • Phone: 914-329-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: