Provider Demographics
NPI:1407635220
Name:SQUIRES, MARISSA (LMSW)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 OFFICE PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7103
Mailing Address - Country:US
Mailing Address - Phone:314-931-2132
Mailing Address - Fax:314-788-3008
Practice Address - Street 1:650 OFFICE PKWY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7103
Practice Address - Country:US
Practice Address - Phone:314-838-1465
Practice Address - Fax:314-788-3008
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023032646104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker