Provider Demographics
NPI:1326656422
Name:BOHRER, MARISSA HAYLEY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:HAYLEY
Last Name:BOHRER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3166 N LINCOLN AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3119
Mailing Address - Country:US
Mailing Address - Phone:312-600-7832
Mailing Address - Fax:
Practice Address - Street 1:3166 N LINCOLN AVE STE 217
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3119
Practice Address - Country:US
Practice Address - Phone:312-600-7832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150104481104100000X
IL1490238871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker