Individual
MS. MARISSA BAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
55 JOHN A CUMMINGS WAY, WOONSOCKET, RI 02895-3247
(401) 235-7000
Mailing address
2 FERA ST, #107, NORTH PROVIDENCE, RI 02904-4100
(401) 235-7000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW01731
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000031091
BLUE CROSS
RI
01
—
0000041302
BLUE CHIP
RI
05
—
MB50349
—
RI
Enumeration date
07/10/2006
Last updated
07/08/2007
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