Provider Demographics
NPI:1124028253
Name:STAPLETON, MARCIA (LICSW)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6139
Mailing Address - Country:US
Mailing Address - Phone:507-225-0450
Mailing Address - Fax:507-779-7182
Practice Address - Street 1:881 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6139
Practice Address - Country:US
Practice Address - Phone:507-225-0450
Practice Address - Fax:507-779-7182
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1124028253Medicaid
MN657S6STOtherBLUE CROSS BLUE SHIELD