Provider Demographics
NPI:1497268338
Name:BUMAGNY, MARISSA LIAN MARINELLO (LMSW)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:LIAN MARINELLO
Last Name:BUMAGNY
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 1:605 S FREDERICK AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1241
Mailing Address - Country:US
Mailing Address - Phone:667-668-2566
Mailing Address - Fax:
Practice Address - Street 1:604 S FREDERICK AVE STE 211
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1282
Practice Address - Country:US
Practice Address - Phone:667-668-2566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 390200000X
MD278821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program