Marisa P Distefano LPC LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

MARISA P DISTEFANO LPC LLC

Practice address

172 Franklin Ave Ste 4B
Ridgewood, NJ 07450-3229

Phone

(201) 446-4669

NPI assigned

Dec 16, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Marisa Distefano, LPCNPI 1720546260

Title

Owner

Phone

(201) 446-4669

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marisa Distefano, LPC

  • Mental Health Counselor
  • Ridgewood, NJ
  • NPI 1720546260
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735257600000",
    "number": "1194532861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 FRANKLIN AVE STE 4B",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503229",
            "telephone_number": "201-446-4669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 FRANKLIN AVE STE 4B",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503229",
            "telephone_number": "201-446-4669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "422 Cedar Hill Ave",
            "address_purpose": "LOCATION",
            "city": "Wyckoff",
            "state": "NJ",
            "postal_code": "074812219",
            "country_code": "US",
            "telephone_number": "201-446-4669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MARISA P DISTEFANO LPC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-16",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A",
        "authorized_official_last_name": "DISTEFANO",
        "authorized_official_first_name": "MARISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-446-4669",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marilen T Marcelo
• Marek Belz LLC
• Catherine M Maresca Berezansky, LCSW
• Margaret C. Fraser MD
• Sharon V Marigliani, PHD
• Marj Swain Bernstein LCSW LLC
• Barbara Markell, L.C.S.W.
• George Joseph Markowitz, MD
• Kendall Marquard
• Randy F Marrinan, MD

• Mental Health Counselor in Ridgewood, NJ
• Providers in Ridgewood, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.