Provider Demographics
NPI:1053037291
Name:FRANKLIN, MARISSA JANE (MS , EDS)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:JANE
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:MS , EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 E BASIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4200
Mailing Address - Country:US
Mailing Address - Phone:302-323-2712
Mailing Address - Fax:
Practice Address - Street 1:318 E BASIN RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4200
Practice Address - Country:US
Practice Address - Phone:302-323-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE247934103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool