Provider Demographics
NPI:1477354496
Name:LAWRENCE, MARISSA (LCSW)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:O'NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:31 WOODWORTH ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1341
Mailing Address - Country:US
Mailing Address - Phone:585-490-2971
Mailing Address - Fax:
Practice Address - Street 1:6539 ANTHONY DR STE A
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1441
Practice Address - Country:US
Practice Address - Phone:585-398-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093974-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical