Provider Demographics
NPI:1366723215
Name:MAKI, MARISSA LEE (LMHC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LEE
Last Name:MAKI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORWELL ST.
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056
Mailing Address - Country:US
Mailing Address - Phone:617-605-1715
Mailing Address - Fax:
Practice Address - Street 1:258 MAIN STREET SUITE 7
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052
Practice Address - Country:US
Practice Address - Phone:508-242-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9906101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program