Individual
MRS. MARISSA LEIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
88 BARRETT AVE, BAYPORT, NY 11705-1410
(631) 455-9820
Mailing address
88 BARRETT AVE, BAYPORT, NY 11705-1410
(631) 455-9820
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
06/08/2023
Last updated
06/08/2023
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