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General NPI Number Information
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NPI Number | 1427569706
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Entity Type | Individual
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Provider Name | MARISSA DECESARIS PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/13/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 3300 HENRY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1121
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Country | US
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Telephone | 215-254-2069
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Fax |
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Provider Business Mailing Address
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Address Line | 700 S 17TH ST APT 201N
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1939
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Country | US
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Telephone | 609-230-7534
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Fax |
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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 | SP017981
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License Number State | PA
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