Provider Demographics
NPI:1427527498
Name:FURLONG, MARISA (MSW, LISW)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:FURLONG
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:162-445-3862
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-5334
Practice Address - Country:US
Practice Address - Phone:216-445-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802453104100000X
OHI.21033231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS.1802453OtherSTATE OF OHIO COUNSELOR, SOCIAL WORK & MARRIAGE AND FAMILY THERAPIST BOARD
OHI.2103323OtherSTATE OF OHIO COUNSELOR, SOCIAL WORK & MARRIAGE AND FAMILY THERAPIST BOARD