Provider Demographics
NPI:1669045092
Name:CAMPOS, MARISSA (LICASW)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:LICASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 BELMONTE LN
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1251
Mailing Address - Country:US
Mailing Address - Phone:425-770-6013
Mailing Address - Fax:
Practice Address - Street 1:3044 BELMONTE LN
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1251
Practice Address - Country:US
Practice Address - Phone:425-770-6013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC611721281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical