Provider Demographics
NPI:1023223419
Name:MAREK, PATRICIA A (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:MAREK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 11TH STREET SUITE 201
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7065
Mailing Address - Country:US
Mailing Address - Phone:360-647-2808
Mailing Address - Fax:360-752-0037
Practice Address - Street 1:1201 11TH STREET SUITE 201
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7065
Practice Address - Country:US
Practice Address - Phone:360-647-2808
Practice Address - Fax:360-752-0037
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000756103T00000X, 103TB0200X, 103TC0700X, 103TH0004X, 103TH0100X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
R31834OtherUPN
WA7012479Medicaid