Provider Demographics
NPI:1760174650
Name:CARDOSI, MARISSA ANNE (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANNE
Last Name:CARDOSI
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 KRUME CT APT 1333
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3892
Mailing Address - Country:US
Mailing Address - Phone:412-584-7215
Mailing Address - Fax:
Practice Address - Street 1:2231 E MILLBROOK RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1746
Practice Address - Country:US
Practice Address - Phone:919-307-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0206231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical