Provider Demographics
NPI:1811350663
Name:CAMPBELL, MARISSA J (LMSW,MSW,BSW)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:LMSW,MSW,BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18 EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5330
Mailing Address - Country:US
Mailing Address - Phone:203-947-6981
Mailing Address - Fax:
Practice Address - Street 1:105 DANBURY RD STE 202
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4148
Practice Address - Country:US
Practice Address - Phone:203-403-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0098771041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTD339229 DANBURYOtherBEACON HEALTH STRATEGIES
CTNOT ELIGIBLEOtherMHN TRICARENORTH
CTPENDINGMedicaid
CT060669107OtherOPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY
CT13802666OtherCAQH
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherUBH/OXFORD FREEDOM/LIBERTY WELLMORE GRP/FACILITY
CT060669107OtherUBH/CONNECTICARE
CTNOT ELIGIBLEOtherMHN MANAGED HEALTH NETWORK
CT060669107OtherUBH/UNITED HEALTHCARE WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTNOT ELIGIBLEOtherMHN MANAGED HEALTH NETWORK
CTPENDINGOtherAETNA BEHAVIORAL HEALTH