Provider Demographics
NPI:1174290662
Name:ZDRAVCHEV, MARCIA LYNN (LSW)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNN
Last Name:ZDRAVCHEV
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-9041
Mailing Address - Country:US
Mailing Address - Phone:330-345-7949
Mailing Address - Fax:
Practice Address - Street 1:2685 ARMSTRONG RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-9041
Practice Address - Country:US
Practice Address - Phone:330-345-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171M00000X
OHS.2208546104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator