Provider Demographics
NPI:1821978941
Name:GILLIO, MARISA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:GILLIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1917
Mailing Address - Country:US
Mailing Address - Phone:203-305-6960
Mailing Address - Fax:
Practice Address - Street 1:11 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1917
Practice Address - Country:US
Practice Address - Phone:203-305-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty