Provider Demographics
NPI:1538943170
Name:LOWE, MARISSA (LMSW)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:LOWE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LOWELL
Other - Middle Name:
Other - Last Name:VANBIENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:21 SAINT PAULS CT APT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2859
Mailing Address - Country:US
Mailing Address - Phone:860-710-6146
Mailing Address - Fax:
Practice Address - Street 1:1182 BROADWAY STE 3C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5403
Practice Address - Country:US
Practice Address - Phone:347-470-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116987-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker