Provider Demographics
NPI:1982380440
Name:MARISSA BLOCK LLC
Entity Type:Organization
Organization Name:MARISSA BLOCK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:BLOCK
Authorized Official - Last Name:KALKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, MA
Authorized Official - Phone:636-399-6160
Mailing Address - Street 1:502 CHARLES STREET AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4206
Mailing Address - Country:US
Mailing Address - Phone:636-399-6160
Mailing Address - Fax:443-233-0231
Practice Address - Street 1:200 E JOPPA RD STE 400
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3109
Practice Address - Country:US
Practice Address - Phone:443-300-6905
Practice Address - Fax:443-233-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health