Provider Demographics
NPI:1760403232
Name:MARINICH, JUDITH (PCC, LICDC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MARINICH
Suffix:
Gender:F
Credentials:PCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38039 W SPAULDING ST
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-6110
Mailing Address - Country:US
Mailing Address - Phone:440-918-1806
Mailing Address - Fax:440-918-1807
Practice Address - Street 1:38039 W SPAULDING ST
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-6110
Practice Address - Country:US
Practice Address - Phone:440-918-1806
Practice Address - Fax:440-918-1807
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0003813101YM0800X
OH981392101YA0400X
OHS-0017842104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker