Provider Demographics
NPI:1396842415
Name:MROZINSKE, ELENA C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:C
Last Name:MROZINSKE
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:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46352-0217
Mailing Address - Country:US
Mailing Address - Phone:219-324-6263
Mailing Address - Fax:219-324-2008
Practice Address - Street 1:318 PINE LAKE AVE
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3061
Practice Address - Country:US
Practice Address - Phone:219-324-6263
Practice Address - Fax:219-324-2008
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004424A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical