Provider Demographics
NPI:1881112811
Name:LEWIS, MARISSA JEANETT (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:JEANETT
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 SANDPIPER CIR APT 201
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5070
Mailing Address - Country:US
Mailing Address - Phone:813-365-8094
Mailing Address - Fax:
Practice Address - Street 1:8094 SANDPIPER CIR
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4907
Practice Address - Country:US
Practice Address - Phone:410-800-4427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist