Healthcare Provider Details

I. General information

NPI: 1457277741
Provider Name (Legal Business Name): MARISSA GUINN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ELM PL
BROOKLYN NY
11201-5355
US

IV. Provider business mailing address

285 SAINT JOHNS PL APT 35
BROOKLYN NY
11238-5634
US

V. Phone/Fax

Practice location:
  • Phone: 817-808-3893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12919901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: