Provider Demographics
NPI:1255108809
Name:AGUIRRE, MARISSA (LLMSW)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26734 CORONATION DR
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5823
Mailing Address - Country:US
Mailing Address - Phone:313-515-4797
Mailing Address - Fax:
Practice Address - Street 1:11480 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2566
Practice Address - Country:US
Practice Address - Phone:313-515-4797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical