Provider Demographics
NPI:1912006701
Name:FORKOSH, MARINA (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:FORKOSH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SOM CENTER RD
Mailing Address - Street 2:SUITE D-20
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2944
Mailing Address - Country:US
Mailing Address - Phone:440-954-4238
Mailing Address - Fax:440-914-0028
Practice Address - Street 1:6200 SOM CENTER RD
Practice Address - Street 2:SUITE D-20
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2944
Practice Address - Country:US
Practice Address - Phone:440-954-4238
Practice Address - Fax:440-914-0028
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 00060701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical