Provider Demographics
NPI:1225282650
Name:SAPPHO, MARISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:SAPPHO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:CUSACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:130 W 97TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6450
Mailing Address - Country:US
Mailing Address - Phone:212-222-6162
Mailing Address - Fax:212-222-6114
Practice Address - Street 1:130 W 97TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6450
Practice Address - Country:US
Practice Address - Phone:212-222-6162
Practice Address - Fax:212-222-6114
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0777861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical