Provider Demographics
NPI:1316095672
Name:RINI, MARY HOLMAN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HOLMAN
Last Name:RINI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 CURTIS DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-9111
Mailing Address - Country:US
Mailing Address - Phone:219-872-8666
Mailing Address - Fax:219-874-4538
Practice Address - Street 1:450 SAINT JOHN RD
Practice Address - Street 2:SUITE 602
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7354
Practice Address - Country:US
Practice Address - Phone:219-872-8666
Practice Address - Fax:219-874-4538
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002710A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN485380Medicare ID - Type UnspecifiedSWANSON CENTER