Provider Demographics
NPI:1154465367
Name:LOSINSKI, MARIEKA DENISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIEKA
Middle Name:DENISE
Last Name:LOSINSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SOUTH HOLLY ST.
Mailing Address - Street 2:STE A
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-773-5664
Mailing Address - Fax:541-773-5667
Practice Address - Street 1:145 SOUTH HOLLY ST
Practice Address - Street 2:STE A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-773-5664
Practice Address - Fax:541-773-5667
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL24971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL2497OtherLICENSE NUMBER