Healthcare Provider Details

I. General information

NPI: 1306193958
Provider Name (Legal Business Name): MARISSA WARNE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 BLACK HORSE PIKE STE 501
PLEASANTVILLE NJ
08232-2967
US

IV. Provider business mailing address

8025 BLACK HORSE PIKE STE 501
PLEASANTVILLE NJ
08232-2967
US

V. Phone/Fax

Practice location:
  • Phone: 609-822-7979
  • Fax: 609-855-7980
Mailing address:
  • Phone: 609-822-7979
  • Fax: 609-855-7980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05707800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: