Provider Demographics
NPI:1568906204
Name:BASKIN, MARISA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:BASKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 COBB RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-4336
Mailing Address - Country:US
Mailing Address - Phone:772-212-2952
Mailing Address - Fax:
Practice Address - Street 1:828 SW PALM CITY RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2820
Practice Address - Country:US
Practice Address - Phone:772-212-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC194151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical