Provider Demographics
NPI:1972878544
Name:MARCINKIEWICZ, EWA
Entity Type:Individual
Prefix:
First Name:EWA
Middle Name:
Last Name:MARCINKIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9015 MOUNTAIN RIDGE DRIVE STE. 200
Mailing Address - Street 2:HOUSTON BLDG.
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7303
Mailing Address - Country:US
Mailing Address - Phone:832-315-1856
Mailing Address - Fax:254-773-0919
Practice Address - Street 1:9015 MOUNTAIN RIDGE DR STE 200
Practice Address - Street 2:HOUSTON BLDG.,
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7303
Practice Address - Country:US
Practice Address - Phone:832-315-1856
Practice Address - Fax:254-773-0919
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health