Provider Demographics
NPI:1619548963
Name:SMOTHERS, MARISSA L (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:L
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 HUNT HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2354
Mailing Address - Country:US
Mailing Address - Phone:410-627-3483
Mailing Address - Fax:
Practice Address - Street 1:3901 HUNT HARBOR RD
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-2354
Practice Address - Country:US
Practice Address - Phone:410-627-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD230831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical