Provider Demographics
NPI:1952573446
Name:WARCZINSKY, LAURA SUZANNE
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:SUZANNE
Last Name:WARCZINSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:SUZANNE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 CAROLINA
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1241
Mailing Address - Country:US
Mailing Address - Phone:810-300-5837
Mailing Address - Fax:
Practice Address - Street 1:2186 WATER ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-2543
Practice Address - Country:US
Practice Address - Phone:810-967-6911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1297584104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker