Healthcare Provider Details

I. General information

NPI: 1609846575
Provider Name (Legal Business Name): MARVIN L. HINZ MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 CHERRY ST
LEAVENWORTH WA
98826-1069
US

IV. Provider business mailing address

144 CHERRY ST
LEAVENWORTH WA
98826-1069
US

V. Phone/Fax

Practice location:
  • Phone: 509-433-4029
  • Fax: 509-823-1664
Mailing address:
  • Phone: 509-433-4029
  • Fax: 509-823-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00008462
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: