Healthcare Provider Details

I. General information

NPI: 1548926959
Provider Name (Legal Business Name): MARISSA STRADER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 VILLANOVA CT
BERLIN NJ
08009-2219
US

IV. Provider business mailing address

3 VILLANOVA CT
BERLIN NJ
08009-2219
US

V. Phone/Fax

Practice location:
  • Phone: 609-481-8095
  • Fax:
Mailing address:
  • Phone: 609-481-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06121900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: