Healthcare Provider Details

I. General information

NPI: 1780972976
Provider Name (Legal Business Name): MARISSA RUANE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 RAILROAD AVE STE 317
GORHAM ME
04038-1546
US

IV. Provider business mailing address

7 RAILROAD AVE STE 317
GORHAM ME
04038-1546
US

V. Phone/Fax

Practice location:
  • Phone: 207-222-0309
  • Fax:
Mailing address:
  • Phone: 207-222-0309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0890073005
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0890073005
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC13688
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: