Provider Demographics
NPI:1124016290
Name:WARD, MARCIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:
Last Name:WARD
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 1:330 LOUISIANA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1470
Mailing Address - Country:US
Mailing Address - Phone:419-874-9488
Mailing Address - Fax:419-874-4822
Practice Address - Street 1:316 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1461
Practice Address - Country:US
Practice Address - Phone:419-874-3212
Practice Address - Fax:419-874-3227
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5761103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
203431OtherANTHEM
OHL2274560Medicaid
P33983Medicare UPIN
OHL2274560Medicaid