Provider Demographics
NPI:1841868882
Name:MCINERNEY, MARISSA (LMFT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:MCINERNEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BRIDGE ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-2833
Mailing Address - Country:US
Mailing Address - Phone:203-598-6691
Mailing Address - Fax:
Practice Address - Street 1:1095B S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3432
Practice Address - Country:US
Practice Address - Phone:203-598-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2467106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist