Active NPI
Marissa Rose Pena, LCSW
- Clinical Social Worker
- JB Andrews, MD
National Provider Identifier
1588869739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C-07302
- Practice address
- 1060 W Perimeter Rd
JB Andrews, MD 20762-6602 - Phone
- (240) 857-7186
- NPI assigned
- Jun 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 11716 | TX | |
| Clinical Social Worker | 1041C0700X | 27077 | MD | |
| Clinical Social Worker | 1041C0700X | C-07302 | NM | Primary |
Addresses
Primary practice location
1060 W Perimeter Rd
JB Andrews, MD 20762-6602
Mailing address
3922 Old Columbia Pike
Ellicott City, MD 21043-5411
Phone (410) 310-4639
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LCSW-C | Other | MD | CLINICAL SOCIAL WORKER |
| LCDC | Other | TX | LICENSED CHEMICAL DEPENDENCY COUNSELOR |
| LCSW | Other | NM | CLINICAL SOCIAL WORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11716 | TX | MD | Professional Counselor |
| 27077 | MD | MD | Clinical Social Worker |
| C-07302 | NM | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621728000000",
"number": "1588869739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3922 OLD COLUMBIA PIKE",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210435411",
"telephone_number": "410-310-4639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1060 W PERIMETER RD",
"city": "JB ANDREWS",
"state": "MD",
"postal_code": "207626602",
"telephone_number": "240-857-7186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENA",
"first_name": "MARISSA",
"middle_name": "ROSE",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-18",
"last_updated": "2021-05-23",
"certification_date": "2021-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "11716",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "27077",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NM",
"license": "C-07302",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLINICAL SOCIAL WORKER",
"identifier": "LCSW-C",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED CHEMICAL DEPENDENCY COUNSELOR",
"identifier": "LCDC",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLINICAL SOCIAL WORK",
"identifier": "LCSW",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in JB Andrews, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.