Provider Demographics
NPI:1457521502
Name:ZEITLER, MARJORIE S (MSW)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:S
Last Name:ZEITLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N MAIN ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1625
Mailing Address - Country:US
Mailing Address - Phone:574-234-3515
Mailing Address - Fax:574-234-3565
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:SUITE 305
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1625
Practice Address - Country:US
Practice Address - Phone:574-234-3515
Practice Address - Fax:574-234-3565
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200375890AMedicaid