Healthcare Provider Details

I. General information

NPI: 1750140364
Provider Name (Legal Business Name): RICH MARCIS LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SE 13TH ST
GRAND RAPIDS MN
55744-0015
US

IV. Provider business mailing address

413 SE 13TH ST
GRAND RAPIDS MN
55744-0015
US

V. Phone/Fax

Practice location:
  • Phone: 218-999-9908
  • Fax:
Mailing address:
  • Phone: 218-999-9908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: