Provider Demographics
NPI:1659193936
Name:POHL, MARISSA A (MSW,LSW)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:A
Last Name:POHL
Suffix:
Gender:F
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 W LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-5766
Mailing Address - Country:US
Mailing Address - Phone:616-260-1003
Mailing Address - Fax:
Practice Address - Street 1:8445 KEYSTONE CROSSING
Practice Address - Street 2:STE 180-REMOTE
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240
Practice Address - Country:US
Practice Address - Phone:463-203-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33012479A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker