Provider Demographics
NPI:1548893555
Name:MARICK, STEPHEN DARIO (LCSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DARIO
Last Name:MARICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:STEVE
Other - Middle Name:DARIO
Other - Last Name:MARICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2600 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2682
Mailing Address - Country:US
Mailing Address - Phone:503-948-2800
Mailing Address - Fax:503-947-2876
Practice Address - Street 1:2600 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2682
Practice Address - Country:US
Practice Address - Phone:503-948-2800
Practice Address - Fax:503-947-2876
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL83691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty