Healthcare Provider Details

I. General information

NPI: 1427713833
Provider Name (Legal Business Name): MARISSA ROMANOVITCH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 CENTRAL AVE STE 126
DOVER NH
03820-2506
US

IV. Provider business mailing address

835 CENTRAL AVE STE 126
DOVER NH
03820-2506
US

V. Phone/Fax

Practice location:
  • Phone: 413-324-5029
  • Fax:
Mailing address:
  • Phone: 413-324-5029
  • 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 PLANTE ROMANOVITCH
Title or Position: AUTHORIZED OFFICIAL
Credential: LICSW
Phone: 413-324-5029