Maple, Marissa L
Maple, Marissa L is an individual health care provider with primary practice located at 1187 Queen St , Southington CT 06489-1266. She recently has 2 registered licenses in different health care specialties including Pharmacy Service Providers / Pharmacy Technician, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Maple, Marissa L can be contacted via phone (860) 255-4502.Contact Information
Primary practice address
1187 Queen St
Southington CT 06489-1266
Phone: (860) 255-4502
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Pharmacy Service Providers / Pharmacy Technician | 183700000X | PTN.0011947 | Connecticut |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 9267 | Connecticut |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X |
Profile Details
| NPI number | 1366861551 |
|---|---|
| LBN Legal business name | Maple, Marissa L |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 15th, 2014 |
| Last updated | Oct 21st, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366861551 | NPPES |
| Connecticut | Other | 060669107 | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| Connecticut | Other | PENDING | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| Connecticut | MEDICAID | 008060347 | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| Connecticut | Other | 060669107 | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| Connecticut | Other | PENDING | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| Connecticut | Other | PENDING | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| Connecticut | Other | 060669107 | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| Connecticut | Other | 060669107 | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| Connecticut | Other | 060669107 | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| Connecticut | Other | D339209 | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| Connecticut | Other | 13559521 | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
| Connecticut | Other | PENDING | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY |
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