Provider Demographics
NPI:1174027916
Name:ALLNUT, MARISA GRILLO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:GRILLO
Last Name:ALLNUT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6878 ROLLING CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-6123
Mailing Address - Country:US
Mailing Address - Phone:315-345-0596
Mailing Address - Fax:
Practice Address - Street 1:6878 ROLLING CREEK WAY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-6123
Practice Address - Country:US
Practice Address - Phone:315-944-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040115911041C0700X
NY0860941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical