Provider Demographics
NPI:1316166499
Name:MARINKO-SHRIVERS, JEFF (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:MARINKO-SHRIVERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7852 HOLDERMAN ST
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-6004
Mailing Address - Country:US
Mailing Address - Phone:614-306-2716
Mailing Address - Fax:740-548-0702
Practice Address - Street 1:7852 HOLDERMAN ST
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-6004
Practice Address - Country:US
Practice Address - Phone:614-306-2716
Practice Address - Fax:740-548-0702
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X
OH5341103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities