Provider Demographics
NPI:1578850269
Name:MARCZYK, LETICIA (MSW)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:MARCZYK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:
Other - Last Name:SERRANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2237 W BALL RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5314
Mailing Address - Country:US
Mailing Address - Phone:714-490-2750
Mailing Address - Fax:714-490-2757
Practice Address - Street 1:2237 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5314
Practice Address - Country:US
Practice Address - Phone:714-490-2750
Practice Address - Fax:714-490-2757
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 251291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA987654321Medicaid