Provider Demographics
NPI:1033898374
Name:BRICENO, MARISSA E (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:E
Last Name:BRICENO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E 172ND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-5802
Mailing Address - Country:US
Mailing Address - Phone:646-830-0581
Mailing Address - Fax:
Practice Address - Street 1:910 E 172ND ST FL 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-5802
Practice Address - Country:US
Practice Address - Phone:646-830-0581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120240104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker