Healthcare Provider Details

I. General information

NPI: 1558452300
Provider Name (Legal Business Name): MARILYN BRINK LISW-S BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 OHIO DR
GROVE CITY OH
43123-4835
US

IV. Provider business mailing address

1955 OHIO DR
GROVE CITY OH
43123-4835
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5816
  • Fax: 614-257-5801
Mailing address:
  • Phone: 614-257-5816
  • Fax: 614-257-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI10073
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: