Provider Demographics
NPI:1417113689
Name:BARTCZAK, MARIE LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LYNN
Last Name:BARTCZAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11521 BLOCKER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-4654
Mailing Address - Country:US
Mailing Address - Phone:530-886-0965
Mailing Address - Fax:530-889-0594
Practice Address - Street 1:11521 BLOCKER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4654
Practice Address - Country:US
Practice Address - Phone:530-886-0965
Practice Address - Fax:530-889-0594
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT38100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist