Marissa Ann Otten, LGSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P024523 Issued in NC

Practice address

1030 N Rogers LN Ste 121
Raleigh, NC 27610-6083

Phone

(910) 216-9530

NPI assigned

Sep 2, 2026

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 names 1

• Marissa Ann Gillham Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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

{
    "created_epoch": "1788307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788307200000",
    "number": "1730098161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8726 CHURCH CIR",
            "city": "CLEAR LAKE",
            "state": "MN",
            "postal_code": "553194520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 N ROGERS LN STE 121",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276106083",
            "telephone_number": "910-216-9530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTEN",
        "first_name": "MARISSA",
        "middle_name": "ANN",
        "credential": "LGSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-09-02",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "36136",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P024523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "GILLHAM",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Barry S Ostrow, MD
• Osvold Psychotherapy & Testing, Inc.
• Lise Leigh Osvold, PH.D., L.P.
• Islam Mohamed Othman, M.D.
• Elyse Otten
• Hannah Leake Otterman
• Amy Otterson, LPC
• Staci Otto, CCC-SLP
• Mustafa Oudeh, PHARMD
• Our Building Together LLC

• Clinical Social Worker in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.