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General NPI Number Information
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NPI Number | 1598001380
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Entity Type | Individual
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Provider Name | MARISA L VALDISERRA LPC
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Gender | Female
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Dates
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Enumeration Date | 12/24/2012
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 100 RIVERVIEW CTR STE 240
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3489
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Country | US
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Telephone | 860-373-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 100 HUNTING HILL AVE
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4314
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Country | US
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Telephone | 860-227-1369
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2721
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License Number State | CT
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