Healthcare Provider Details

I. General information

NPI: 1215892518
Provider Name (Legal Business Name): MARISSA CARLANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISSA LEBLANC

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HOLLY CT
HAMILTON NJ
08619-4632
US

IV. Provider business mailing address

25 HOLLY CT
HAMILTON NJ
08619-4632
US

V. Phone/Fax

Practice location:
  • Phone: 609-502-5226
  • Fax:
Mailing address:
  • Phone: 609-502-5226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01214700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: