Individual provider Active NPI

Marissa Block Kalkstein, MA, LCPC

  • Professional Counselor
  • Towson, MD
National Provider Identifier
1104390012
Registry record updated Jun 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LC10425 Issued in MD
Practice address
200 E Joppa Rd Ste 400
Towson, MD 21286-3109
Phone
(410) 828-0101
Fax
(410) 828-6262
NPI assigned
Jan 14, 2019
Last updated
Jun 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LC10425 MD Primary

Addresses

Primary practice location

200 E Joppa Rd Ste 400
Towson, MD 21286-3109

Mailing address

502 Charles Street Ave
Towson, MD 21204-4206
Phone (636) 399-6160

Other identifiers 1

IdentifierTypeStateIssuer
LGP8630OtherMDBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251126001777 MO Practitioner - Mental Health Counselor 4587076799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

305 W Pennsylvania Ave
Towson, MD 21204-4413

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
LC10425MDMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Marissa Block LLC Professional CurrentSince Apr 22, 2018 Accepting new patients
Marissa Block LLC CurrentSince Jul 2, 2023 Accepting new patients

Locations

200 E Joppa Rd
Ste 400
Towson, MD 21286
Phone (443) 300-6905

305 W Pennsylvania Ave
Towson, MD 21204
Phone (443) 300-6905

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1104390012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 CHARLES STREET AVE",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212044206",
            "telephone_number": "636-399-6160",
            "fax_number": "443-233-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E JOPPA RD STE 400",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212863109",
            "telephone_number": "410-828-0101",
            "fax_number": "410-828-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALKSTEIN",
        "first_name": "MARISSA",
        "middle_name": "BLOCK",
        "credential": "MA, LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-14",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC10425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "LGP8630",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Towson, MD

Sources for this page

Verify at the official NPI Registry.