Provider Demographics
NPI:1598121600
Name:GRUZMARK, MARINA VICTORIA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:VICTORIA
Last Name:GRUZMARK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:MARINA
Other - Middle Name:VICTORIA
Other - Last Name:ASIPENKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9655 WOODS DR.
Mailing Address - Street 2:UNIT 1811
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:847-630-7910
Mailing Address - Fax:
Practice Address - Street 1:9655 WOODS DR.
Practice Address - Street 2:UNIT 1811
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-630-7910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health