Provider Demographics
NPI:1548648017
Name:MARVIN, RICHARD A (LSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:MARVIN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21515 CHAGRIN BLVD. SUITE 203
Mailing Address - Street 2:HOPE BEHAVIORAL HEALTH LLC
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:800-642-4560
Mailing Address - Fax:888-391-5442
Practice Address - Street 1:7196 SOM CENTER RD.
Practice Address - Street 2:OUR REDEEMER LUTHERAN CHURCH
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139
Practice Address - Country:US
Practice Address - Phone:800-642-4560
Practice Address - Fax:888-391-5442
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1000019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker