Healthcare Provider Details

I. General information

NPI: 1457863672
Provider Name (Legal Business Name): MARISA GREAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MERRIMACK ST
HAVERHILL MA
01830-5210
US

IV. Provider business mailing address

615 ELSINORE PL
CINCINNATI OH
45202-1459
US

V. Phone/Fax

Practice location:
  • Phone: 833-510-4357
  • Fax: 866-460-2997
Mailing address:
  • Phone: 833-510-4357
  • Fax: 866-460-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW126363
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: