Provider Demographics
NPI:1104390012
Name:KALKSTEIN, MARISSA BLOCK (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:BLOCK
Last Name:KALKSTEIN
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CHARLES STREET AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4206
Mailing Address - Country:US
Mailing Address - Phone:636-399-6160
Mailing Address - Fax:443-233-0231
Practice Address - Street 1:200 E JOPPA RD STE 400
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3109
Practice Address - Country:US
Practice Address - Phone:410-828-0101
Practice Address - Fax:410-828-6262
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10425101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP8630OtherBCBS