Provider Demographics
NPI:1114194255
Name:GATIEN, EDA MARIELA
Entity Type:Individual
Prefix:
First Name:EDA
Middle Name:MARIELA
Last Name:GATIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EDA
Other - Middle Name:MARIELA
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 7TH AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1176
Mailing Address - Country:US
Mailing Address - Phone:906-786-6441
Mailing Address - Fax:906-786-5859
Practice Address - Street 1:2500 7TH AVE S STE 100
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1176
Practice Address - Country:US
Practice Address - Phone:906-786-6441
Practice Address - Fax:906-786-5859
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 104100000X
MI68010996911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker