Provider Demographics
NPI:1316468903
Name:JONES, MARISSA JANELL (LSW)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:JANELL
Last Name:JONES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10092 BELMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-1104
Mailing Address - Country:US
Mailing Address - Phone:216-299-0846
Mailing Address - Fax:
Practice Address - Street 1:24100 CHAGRIN BLVD STE 330
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5552
Practice Address - Country:US
Practice Address - Phone:800-642-4560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2017-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1700224104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker