Provider Demographics
NPI:1336223874
Name:MARCINKIEWICZ, RANDI PETTERSEN (MA)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:PETTERSEN
Last Name:MARCINKIEWICZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CHIPPEWA ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARDSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01452-1550
Mailing Address - Country:US
Mailing Address - Phone:978-928-5554
Mailing Address - Fax:978-630-5754
Practice Address - Street 1:38 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:HUBBARDSTON
Practice Address - State:MA
Practice Address - Zip Code:01452-1550
Practice Address - Country:US
Practice Address - Phone:978-928-5554
Practice Address - Fax:978-630-5754
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health