Provider Demographics
NPI:1861466187
Name:CAREY, MARISSA E (PHD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:E
Last Name:CAREY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 COOMBS FARM DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508
Mailing Address - Country:US
Mailing Address - Phone:304-554-0504
Mailing Address - Fax:304-554-0505
Practice Address - Street 1:9000 COOMBS FARM DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508
Practice Address - Country:US
Practice Address - Phone:304-554-0504
Practice Address - Fax:304-554-0505
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV71505103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003178Medicaid
6033521Medicare PIN
WVQ42622E879Medicare PIN