Provider Demographics
NPI:1174291355
Name:KRIS, MARISSA (LICSW)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:KRIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:ORTAGUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIT 5320 BOX 122
Mailing Address - Street 2:
Mailing Address - City:DPO
Mailing Address - State:AE
Mailing Address - Zip Code:09726-0122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13125 RIVERS BEND BLVD # 110
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-2699
Practice Address - Country:US
Practice Address - Phone:863-604-7748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500823271041C0700X
VA09040153751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical