Provider Demographics
NPI:1144473349
Name:WOODWORTH, MARISA MARIE (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:MARISA
Middle Name:MARIE
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 SUNSET HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-3718
Mailing Address - Country:US
Mailing Address - Phone:267-549-5772
Mailing Address - Fax:
Practice Address - Street 1:811 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4844
Practice Address - Country:US
Practice Address - Phone:610-696-0325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional