Healthcare Provider Details

I. General information

NPI: 1295296606
Provider Name (Legal Business Name): MARISSA FRUMENTO LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 COLUMBIA PARK RD
LANDOVER MD
20785-3970
US

IV. Provider business mailing address

2800 WISCONSIN AVE NW APT 803
WASHINGTON DC
20007-4706
US

V. Phone/Fax

Practice location:
  • Phone: 301-925-1360
  • Fax:
Mailing address:
  • Phone: 240-481-0961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20379
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: