Provider Demographics
NPI:1417216169
Name:MARCINKO, MICHAEL B (SC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:MARCINKO
Suffix:
Gender:M
Credentials:SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CERASI DRIVE
Mailing Address - Street 2:APT 112
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122
Mailing Address - Country:US
Mailing Address - Phone:412-445-9878
Mailing Address - Fax:
Practice Address - Street 1:100 CERASI DR
Practice Address - Street 2:APT 112
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-4207
Practice Address - Country:US
Practice Address - Phone:412-445-9878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker