| Doctor Name: | MARISA L VALDISERRA |
| NPI Number: | 1598001380 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | |
| Business Practice Address: | 255 Hempstead St New London, CT - 063206204 |
| Business Phone Number: | 8604432896 |
| Business Fax Number: | 8604425909 |
| Mailing Address: | 31 Laurel Grove Dr, HIGGANUM |
| State: | CT |
| Postal Code: | 064414355 |
| Phone Number: | 8602271369 |
| Fax Number: | |
| NPI Enumeration Date: | 12/24/2012 |
| NPI Last Update Date: | 12/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |