Provider Demographics
NPI:1083904882
Name:CORMIER, MARISSA BROOK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:BROOK
Last Name:CORMIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MARISSA
Other - Middle Name:BROOK
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:27 NAEK RD STE 4
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3965
Mailing Address - Country:US
Mailing Address - Phone:860-872-9825
Mailing Address - Fax:860-870-9384
Practice Address - Street 1:27 NAEK RD STE 4
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3965
Practice Address - Country:US
Practice Address - Phone:860-872-9825
Practice Address - Fax:860-870-9384
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)