Healthcare Provider Details

I. General information

NPI: 1487908232
Provider Name (Legal Business Name): MARISHA PEARSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISHA DAVIS LCSW

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 E MAIN ST
PLAINVILLE CT
06062-4903
US

IV. Provider business mailing address

30 ALEXANDER RD
BLOOMFIELD CT
06002-2860
US

V. Phone/Fax

Practice location:
  • Phone: 860-856-3781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: