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General NPI Number Information
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NPI Number | 1114742418
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Entity Type | Individual
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Provider Name | MARINA MARISTCH PMHNP
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Gender | Female
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 771 ROUTE 70 E STE D100
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City | MARLTON
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State | NJ
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Zip | 08053-2356
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Country | US
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Telephone | 856-446-4728
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Fax | 856-230-7229
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Provider Business Mailing Address
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Address Line | 765 ROUTE 70 E BLDG A-101
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City | MARLTON
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State | NJ
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Zip | 08053-2341
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Country | US
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Telephone | 856-446-4728
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Fax | 856-230-7229
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ15217000
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License Number State | NJ
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