Healthcare Provider Details

I. General information

NPI: 1134924434
Provider Name (Legal Business Name): MARISSA J BIEDERMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GROSSMAN DR STE 1077
BRAINTREE MA
02184-4967
US

IV. Provider business mailing address

22 BATES RD STE 292
MASHPEE MA
02649-3280
US

V. Phone/Fax

Practice location:
  • Phone: 508-299-7075
  • Fax:
Mailing address:
  • Phone: 617-922-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARISSA J BIEDERMAN
Title or Position: CLINICAL SOCIAL WORKER
Credential: LICSW
Phone: 617-922-3777