Healthcare Provider Details

I. General information

NPI: 1831093228
Provider Name (Legal Business Name): MARISSA BLOCK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W PENNSYLVANIA AVE
TOWSON MD
21204-4413
US

IV. Provider business mailing address

305 W PENNSYLVANIA AVE
TOWSON MD
21204-4413
US

V. Phone/Fax

Practice location:
  • Phone: 443-300-6905
  • Fax: 443-233-0231
Mailing address:
  • Phone: 443-300-6905
  • Fax: 443-233-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARISSA BLOCK KALKSTEIN
Title or Position: CEO & OWNER
Credential: LCPC-S
Phone: 443-300-6905