Marissa Lynn Fitzgibbon

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

29226 Issued in CA

Practice address

1 Main St
San Quentin, CA 94964-1000

Phone

(415) 454-1460

NPI assigned

Sep 11, 2007

Last updated

Apr 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Marissa Lynn Fernandes Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Corrections and Rehabilitation-Headquarters

  dba Neumiller Infirmary Pharmacy

  • Pharmacy
  • San Quentin, CA
  • NPI 1922308642
  NPD

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650499200000",
    "number": "1255526356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22505 WOODROE AVE",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945413410",
            "telephone_number": "510-613-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MAIN ST",
            "city": "SAN QUENTIN",
            "state": "CA",
            "postal_code": "949641000",
            "telephone_number": "415-454-1460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGIBBON",
        "first_name": "MARISSA",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-11",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "29226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "FERNANDES",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Reyna Downey, PHD
• Kenneth Gray Eifert, DDS
• Angelina K Enos, PSYD
• Harun Evcimen, M.D.
• Robin Farrell, PSY.D
• Reina Lorine Fong, PH.D.
• Simonetta Fosci, MSW
• Rebecca French
• Steven Charles Gibbs, MD
• Hillel Greene, ASW

• Clinical Social Worker in San Quentin, CA
• Providers in San Quentin, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.