Provider Demographics
NPI:1184833451
Name:SMITH, MARISA J (IBCLC)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9717 WALTHORNE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4044
Mailing Address - Country:US
Mailing Address - Phone:703-323-7301
Mailing Address - Fax:
Practice Address - Street 1:9717 WALTHORNE CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4044
Practice Address - Country:US
Practice Address - Phone:703-323-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist