Provider Demographics
NPI:1528577277
Name:MAROTTA, MARINNA MIL (LPC LCPC CSAC PMH-C)
Entity Type:Individual
Prefix:MRS
First Name:MARINNA
Middle Name:MIL
Last Name:MAROTTA
Suffix:
Gender:F
Credentials:LPC LCPC CSAC PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 OCONNOR DR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-4269
Mailing Address - Country:US
Mailing Address - Phone:262-374-5251
Mailing Address - Fax:
Practice Address - Street 1:209 OCONNOR DR
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4269
Practice Address - Country:US
Practice Address - Phone:262-374-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16192131101YA0400X
IL180.011635101YP2500X
WI6576125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6576-125OtherLICENSED PROFESSIONAL COUNSELOR
IL180.011635OtherLICENSED CLINICAL PROFESSIONAL COUNSELOR