Provider Demographics
NPI:1609846575
Name:HINZ, MARVIN L (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:L
Last Name:HINZ
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-1069
Mailing Address - Country:US
Mailing Address - Phone:509-433-4029
Mailing Address - Fax:509-823-1664
Practice Address - Street 1:144 CHERRY ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1069
Practice Address - Country:US
Practice Address - Phone:509-433-4029
Practice Address - Fax:509-823-1664
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000084621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1125327Medicaid
WA1125327Medicaid
WAG88590Medicare PIN