Provider Demographics
NPI:1396353801
Name:NEAL, MARISSA A (LCSW-C)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:A
Last Name:NEAL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:A
Other - Last Name:GRAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1812 BALTIMORE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7144
Mailing Address - Country:US
Mailing Address - Phone:443-590-0030
Mailing Address - Fax:888-316-2327
Practice Address - Street 1:1812 BALTIMORE BLVD STE B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7144
Practice Address - Country:US
Practice Address - Phone:443-590-0030
Practice Address - Fax:888-316-2327
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0192911041C0700X
MD189921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical