Provider Demographics
NPI:1396871802
Name:PRINZ, MARCIA HELENE (LCSW)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:HELENE
Last Name:PRINZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 YORK ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3831
Mailing Address - Country:US
Mailing Address - Phone:650-889-0169
Mailing Address - Fax:971-206-8842
Practice Address - Street 1:2622 YORK ST
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3831
Practice Address - Country:US
Practice Address - Phone:650-889-0169
Practice Address - Fax:971-206-8842
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60841101YM0800X, 101YP2500X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional