Provider Demographics
NPI:1245011428
Name:THOMPSON, MARISSA LYNN (LMSW-CC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 HAMMOND ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4610
Mailing Address - Country:US
Mailing Address - Phone:207-941-1612
Mailing Address - Fax:207-941-1634
Practice Address - Street 1:253 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4610
Practice Address - Country:US
Practice Address - Phone:207-941-1612
Practice Address - Fax:207-941-1634
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC226611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical