Provider Demographics
NPI:1922168210
Name:MARCINCZYK, BOZENA TERESA (PHD,LMFT)
Entity Type:Individual
Prefix:DR
First Name:BOZENA
Middle Name:TERESA
Last Name:MARCINCZYK
Suffix:
Gender:F
Credentials:PHD,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 ILLUMINATION LN
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-8398
Mailing Address - Country:US
Mailing Address - Phone:352-314-2296
Mailing Address - Fax:352-314-2296
Practice Address - Street 1:5727 ILLUMINATION LN
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-8398
Practice Address - Country:US
Practice Address - Phone:352-314-2296
Practice Address - Fax:352-314-2296
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA7873OtherREGENCE BLUESHIELD
WA535149Medicaid
WA308375100000OtherPREMERA BLUE CROSS