Provider Demographics
NPI:1053377382
Name:ORESIC, MARI R (MSS, LCSW)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:R
Last Name:ORESIC
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-2437
Mailing Address - Country:US
Mailing Address - Phone:973-264-0023
Mailing Address - Fax:
Practice Address - Street 1:3110 ROUTE 38
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9724
Practice Address - Country:US
Practice Address - Phone:856-235-7126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000990001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2622176000OtherKEYSTONE HEALTHPLAN
2257808OtherCIGNA BEHAVORIAL HEALTH
2622176000OtherMAGELLAN BEHAVORIAL HEALT
0195554000OtherKEYSTONE HEALTHPLAN
2622176000OtherKEYSTONE HEALTHPLAN
L00001Medicare UPIN