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NPI Code Detail

MEDICARE: MARI R ORESIC MSS, LCSW

MEDICARE: MARI R ORESIC MSS, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker44SC00099000NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12622176000OTHERKEYSTONE HEALTHPLAN
22257808OTHERCIGNA BEHAVORIAL HEALTH
32622176000OTHERMAGELLAN BEHAVORIAL HEALT
40195554000OTHERKEYSTONE HEALTHPLAN

General Provider Information

NPI Number : 1053377382
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARI R ORESIC MSS, LCSW
Provider Business Mailing Address
First Line : 85 CRESCENT AVE
Second Line :
City : PASSAIC
State : NJ
Zip : 07055-2437
Country : US
Telephone Number : 973-264-0023
Fax Number :
Provider Business Practice Location Address
First Line : 3110 ROUTE 38
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-9724
Country : US
Telephone Number : 856-235-7126
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 01/14/2022

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Directions to “ MARI R ORESIC MSS, LCSW” Practice Location

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