Provider Demographics
NPI:1003047291
Name:JUDITH MARINICH, INC.
Entity Type:Organization
Organization Name:JUDITH MARINICH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARINICH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LICDC
Authorized Official - Phone:440-918-1806
Mailing Address - Street 1:38039 W SPAULDING ST
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-6110
Mailing Address - Country:US
Mailing Address - Phone:440-918-1806
Mailing Address - Fax:440-918-1807
Practice Address - Street 1:38039 W SPAULDING ST
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-6110
Practice Address - Country:US
Practice Address - Phone:440-918-1806
Practice Address - Fax:440-918-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH981392101YA0400X
OHE-0003813101YP2500X
OHS-0017842104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty