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MARISSA LEE DOUGLAS LMHC
NPI 1417600982
Counselor - Mental Health in Brockport, NY

Active since February 03, 2022PECOS EnrolledAccepts Medicare Assignment
300 WEST AVE, BROCKPORT, NY 14420(585) 637-3905 Get Directions Write a Review

NPPES record last updated: February 3, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Marissa Lee Douglas Lmhc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARISSA LEE DOUGLAS LMHC (NPI 1417600982) is an individual mental health provider in Brockport, New York, licensed in New York (011838-01) and active in the NPI registry since February 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2015).

NPPES Registry Identity

NPI1417600982
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameMARISSA LEE DOUGLASCredential: LMHC
Location Address300 WEST AVEBrockport, NY 14420-1118
Mailing Address1042 Clarkson Parma Tl RdHilton, NY 14468-9709 · (585) 749-3274
Phone(585) 637-3905
Sole ProprietorNo
Medical School CMSOtherGraduated 2015
Enumeration DateFebruary 3, 2022
NPPES CertifiedFebruary 3, 2022
✔ NPI 1417600982 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in NY · 011838-01
300 WEST AVE, Brockport, NY 14420
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Marissa Lee Douglas Lmhc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6507219169
PECOS Enrollment IDI20240130003362
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. KAREN ALLEN RDH
Dental Hygienist
300 WEST AVE
BROCKPORT, NY 14420
Monroe County (585) 637-5319
JOHN L HOFFMANN MD
Family Medicine
300 WEST AVE
BROCKPORT, NY 14420
Monroe County (585) 637-3905
ALISA KIM D.M.D.
Dentist
300 WEST AVE
BROCKPORT, NY 14420
Monroe County (585) 637-3905
TRISTA JAMIE TEETS
Nurse Practitioner (Family)
300 WEST AVE
BROCKPORT, NY 14420
Monroe County (585) 637-3905
MICHELLE L DAMICO
Technician/Technologist (Optician)
300 WEST AVE
BROCKPORT, NY 14420
Monroe County (585) 637-3905
YEN-TUNG ANDY TENG DDS
Dentist (General Practice)
300 WEST AVE
BROCKPORT, NY 14420
Monroe County (585) 706-1771
MS. BAMBI JONES-OLSEN CDA
Dental Assistant
300 WEST AVE
BROCKPORT, NY 14420
Monroe County (585) 637-3905
DR. MARY R HAMILTON D.D.S.
Dentist
300 WEST AVE
BROCKPORT, NY 14420
Monroe County (585) 637-3905

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Marissa Douglas's NPI number?

The NPI number for Marissa Douglas is 1417600982. It was assigned to this individual provider in the NPPES registry on February 3, 2022.

Where is Marissa Douglas located?

Marissa Douglas practices at 300 West Ave, Brockport, NY 14420. The listed phone number is (585) 637-3905.

What is Marissa Douglas's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Marissa Douglas enrolled in Medicare?

Yes. Marissa Douglas is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Marissa Douglas was last updated on February 3, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.