Provider Demographics
NPI:1700530573
Name:MAFFEI, MARISSA
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:MAFFEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631280
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1280
Mailing Address - Country:US
Mailing Address - Phone:610-864-7376
Mailing Address - Fax:877-599-3340
Practice Address - Street 1:280 EXECUTIVE PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1837
Practice Address - Country:US
Practice Address - Phone:207-237-4240
Practice Address - Fax:704-785-8304
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0193241041C0700X
PARBT-22-201380106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician