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General NPI Number Information
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NPI Number | 1548648017
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Entity Type | Individual
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Provider Name | RICHARD A. MARVIN L.S.W.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 7196 SOM CENTER RD. OUR REDEEMER LUTHERAN CHURCH
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City | SOLON
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State | OH
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Zip | 44139
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Country | US
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Telephone | 800-642-4560
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Fax | 888-391-5442
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Provider Business Mailing Address
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Address Line | 21515 CHAGRIN BLVD. SUITE 203 HOPE BEHAVIORAL HEALTH LLC
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City | BEACHWOOD
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State | OH
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Zip | 44122
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Country | US
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Telephone | 800-642-4560
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Fax | 888-391-5442
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1000019
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License Number State | OH
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