Provider Demographics
NPI:1265158232
Name:FAAS, MARISSA (PSYD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:FAAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 7TH AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6014
Mailing Address - Country:US
Mailing Address - Phone:646-352-9011
Mailing Address - Fax:917-464-3662
Practice Address - Street 1:825 SEVENTH AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6014
Practice Address - Country:US
Practice Address - Phone:646-352-9011
Practice Address - Fax:917-464-3662
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02850677Medicaid