Healthcare Provider Details

I. General information

NPI: 1932516671
Provider Name (Legal Business Name): KARIN L MARSICK LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 NORTHLAND DR 200A
MEDINA OH
44256-3441
US

IV. Provider business mailing address

246 NORTHLAND DR 200A
MEDINA OH
44256-3441
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-9195
  • Fax: 330-725-9187
Mailing address:
  • Phone: 330-725-9195
  • Fax: 330-725-9187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS. 0016552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: