Provider Demographics
NPI:1710215199
Name:PATRICIA MARCINIAK, LMSW ACSW LLC
Entity Type:Organization
Organization Name:PATRICIA MARCINIAK, LMSW ACSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASTER SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCINIAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, ACSW
Authorized Official - Phone:517-332-2006
Mailing Address - Street 1:6026 HARKSON DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1513
Mailing Address - Country:US
Mailing Address - Phone:517-332-2006
Mailing Address - Fax:517-332-2006
Practice Address - Street 1:6026 HARKSON DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1513
Practice Address - Country:US
Practice Address - Phone:517-332-2006
Practice Address - Fax:517-332-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801062760251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI251105000OtherMAGELLAN BEHAVIORAL HEALTH
MI0890922Medicare PIN