Provider Demographics
NPI:1821383191
Name:MORIN, MARIA VIRGINIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:VIRGINIA
Last Name:MORIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 LAKE EASTBROOK BLVD. S.E.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5906
Mailing Address - Country:US
Mailing Address - Phone:616-299-9964
Mailing Address - Fax:616-678-3635
Practice Address - Street 1:3737 LAKE EASTBROOK BLVD. S.E.
Practice Address - Street 2:SUITE 204
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5906
Practice Address - Country:US
Practice Address - Phone:616-299-9964
Practice Address - Fax:616-678-3635
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009231103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N59720Medicare PIN