Healthcare Provider Details

I. General information

NPI: 1861466187
Provider Name (Legal Business Name): MARISSA E CAREY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 COOMBS FARM DRIVE SUITE 202
MORGANTOWN WV
26508
US

IV. Provider business mailing address

9000 COOMBS FARM DRIVE SUITE 202
MORGANTOWN WV
26508
US

V. Phone/Fax

Practice location:
  • Phone: 304-554-0504
  • Fax: 304-554-0505
Mailing address:
  • Phone: 304-554-0504
  • Fax: 304-554-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number71505
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: