Marissa Carlson, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LCSW-43558 Issued in ID

Practice address

201 N 8TH St Ste 4
Saint Maries, ID 83861-1869

Phone

(208) 597-7639

Fax

(208) 717-9450

NPI assigned

Aug 28, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Saint Maries Counseling LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Saint Maries, ID
  • NPI 1053997197
  NPD
• Dirne Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Coeur D Alene, ID
  • NPI 1194397240

  Clinical

  NPD (past)
• Dirne Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Coeur D Alene, ID
  • NPI 1255756730

  Social Worker

  NPD (past)

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

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1124631171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13498 E LAY LN",
            "city": "MEDIMONT",
            "state": "ID",
            "postal_code": "838429775",
            "telephone_number": "208-582-4024",
            "fax_number": "208-717-9450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N 8TH ST STE 4",
            "city": "SAINT MARIES",
            "state": "ID",
            "postal_code": "838611869",
            "telephone_number": "208-597-7639",
            "fax_number": "208-717-9450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13498 E Lay Ln",
            "address_purpose": "LOCATION",
            "city": "Medimont",
            "state": "ID",
            "postal_code": "838429775",
            "country_code": "US",
            "telephone_number": "208-582-4024",
            "fax_number": "208-717-9450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "MARISSA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-28",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "39959",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LCSW-43558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "39959",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Craig Austin Burns, MD
• Di Ann Butterfield, PHARMD
• Randall Bradford Choka, FNP
• Rise Kevalshar Collins, LCSW
• County of Benewah
• Peggy L Cuvala, NP
• Sussannie Lucynda Da Costa, M.S., CRC,PSYD (ABD)

• Social Worker in Saint Maries, ID
• Providers in Saint Maries, ID by specialty
• Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.