Healthcare Provider Details

I. General information

NPI: 1538274337
Provider Name (Legal Business Name): CATHY MARINCEL-ROBB LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE W SUITE 435S
SAINT PAUL MN
55114-1052
US

IV. Provider business mailing address

4150 WOODHILL DR
LORETTO MN
55357-9558
US

V. Phone/Fax

Practice location:
  • Phone: 651-714-8007
  • Fax:
Mailing address:
  • Phone: 651-647-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2611
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: