Provider Demographics
NPI:1639221351
Name:MARCINIAK, PATRICIA M (MSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:M
Last Name:MARCINIAK
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 1:6026 HARKSON DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1513
Mailing Address - Country:US
Mailing Address - Phone:517-332-2006
Mailing Address - Fax:517-332-2006
Practice Address - Street 1:6026 HARKSON DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1513
Practice Address - Country:US
Practice Address - Phone:517-332-2006
Practice Address - Fax:517-332-2006
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010627601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI251105000OtherMAGELLAN
MI251105000OtherMAGELLAN