Provider Demographics
NPI:1649685264
Name:MARCIN, KIMBERLY ANN (MA, LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:MARCIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:833 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1507
Mailing Address - Country:US
Mailing Address - Phone:414-345-6388
Mailing Address - Fax:414-344-7739
Practice Address - Street 1:833 N 26TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1507
Practice Address - Country:US
Practice Address - Phone:414-345-6388
Practice Address - Fax:414-344-7739
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5376-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional