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General NPI Number Information
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NPI Number | 1386596260
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Entity Type | Organization
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Legal Business Name | MARINAMINDCARE LTD
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 1701 E LAKE AVE STE 270
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City | GLENVIEW
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State | IL
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Zip | 60025-2088
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Country | US
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Telephone | 847-630-7910
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Fax |
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Provider Business Mailing Address
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Address Line | 9655 WOODS DR UNIT 1811
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City | SKOKIE
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State | IL
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Zip | 60077-4434
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Country | US
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Telephone | 847-630-7910
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARINA GRUZMARK
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Credential | LCPC
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Telephone | 847-630-7910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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