Provider Demographics
NPI:1457417362
Name:MARCEAU, CATHLEEN JOYCE (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:JOYCE
Last Name:MARCEAU
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:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-1137
Mailing Address - Country:US
Mailing Address - Phone:208-664-5941
Mailing Address - Fax:208-667-2403
Practice Address - Street 1:611 E LAKESIDE AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2840
Practice Address - Country:US
Practice Address - Phone:208-664-5941
Practice Address - Fax:208-667-2403
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010015835OtherREGENCE BLUE SHIELD
IDL1922OtherBLUE CROSS OF IDAHO
ID000010015835OtherREGENCE BLUE SHIELD