Provider Demographics
NPI:1225357130
Name:MARCINAK, MONICA LOUISE (MA, LMSW, CAAC)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:LOUISE
Last Name:MARCINAK
Suffix:
Gender:F
Credentials:MA, LMSW, CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 W LORAIN ST APT 104
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3427
Mailing Address - Country:US
Mailing Address - Phone:734-384-8984
Mailing Address - Fax:734-243-0145
Practice Address - Street 1:1001 S RAISINVILLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9754
Practice Address - Country:US
Practice Address - Phone:734-384-8949
Practice Address - Fax:734-243-0145
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI201346101YA0400X
MI68010607701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)