Provider Demographics
NPI:1689001521
Name:GREEMORE, MARISSA LYNN (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN
Last Name:GREEMORE
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:LYNN
Other - Last Name:ROMINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:701 SCOFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-7515
Mailing Address - Country:US
Mailing Address - Phone:661-758-8400
Mailing Address - Fax:
Practice Address - Street 1:2808 LAYTON DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-5756
Practice Address - Country:US
Practice Address - Phone:661-487-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-10
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA316921041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical