Provider Demographics
NPI:1417079351
Name:TURNER, MARISSA ALEXIS (LSW)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:ALEXIS
Last Name:TURNER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-435-4151
Mailing Address - Fax:610-435-3044
Practice Address - Street 1:1245 S CEDAR CREST BLVD STE 303
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6258
Practice Address - Country:US
Practice Address - Phone:610-435-4151
Practice Address - Fax:610-435-3044
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132772104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
41593Medicare UPIN