Provider Demographics
NPI:1073640777
Name:LATHROP, MARLENE L (LMSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:L
Last Name:LATHROP
Suffix:
Gender:F
Credentials:LMSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 RAYBROOK ST SE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7717
Mailing Address - Country:US
Mailing Address - Phone:616-942-4002
Mailing Address - Fax:616-942-4031
Practice Address - Street 1:2020 RAYBROOK ST SE
Practice Address - Street 2:SUITE 203
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7717
Practice Address - Country:US
Practice Address - Phone:616-942-4002
Practice Address - Fax:616-942-4031
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010665291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical