Marissa M Petralia, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY 8173 Issued in FL

Practice address

830 Anchor Rode Dr
Naples, FL 34103-2739

Phone

(239) 234-6333

Fax

(239) 234-6413

NPI assigned

Jul 30, 2010

Last updated

Sep 10, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Premier Psychology, PLLCGroup PAC ID 1850614454, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Premier Psychology, PLLC

  • Psychologist
  • Naples, FL
  • NPI 1023417433
  Medicare reassignment Care Compare group NPD Authorized official
• Gateway Psychological Services, LLC

  • Psychologist
  • St Petersburg, FL
  • NPI 1992257240
  NPD (past)

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

{
    "created_epoch": "1280448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631232000000",
    "number": "1841504966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 ANCHOR RODE DR",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341032739",
            "telephone_number": "239-234-6333",
            "fax_number": "239-234-6413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 ANCHOR RODE DR",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341032739",
            "telephone_number": "239-234-6333",
            "fax_number": "239-234-6413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRALIA",
        "first_name": "MARISSA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-30",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY 8173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tabatha Petersen, LMT, CMT, RMT
• Alicia M. Peterson, A.R.N.P.
• Bailey Peterson, OD
• Sarah M Pethick-Martyniak, PT
• Roodelyne Petit-Homme
• Kyndra Lynn Petrick, ARNP
• Michael John Petrocelli, D.P.M.
• Riley Joshua Petrovich
• Mitchell Lee Petusevsky, MD
• Elizabeth M Pezzello

• Clinical Psychologist in Naples, FL
• Providers in Naples, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.