Provider Demographics
NPI:1679863955
Name:GRODZIN, MARNIE LEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARNIE
Middle Name:LEE
Last Name:GRODZIN
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 1:2725 WIND RIVER LN
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-2999
Mailing Address - Country:US
Mailing Address - Phone:214-793-7714
Mailing Address - Fax:
Practice Address - Street 1:2725 WIND RIVER LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-2999
Practice Address - Country:US
Practice Address - Phone:214-793-7714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX355511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical