| Doctor Name: | MR. MARK MARVALD |
| NPI Number: | 1053330282 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S.S.A., L.I.S.W. |
| License Number: | I-0000253 |
| Business Practice Address: | 26777 Lorain Road Ste 314 North Olmsted, OH - 440703225 |
| Business Phone Number: | 4404763622 |
| Business Fax Number: | |
| Mailing Address: | 26777 Lorain Road, Ste 314 NORTH OLMSTED |
| State: | OH |
| Postal Code: | 440703225 |
| Phone Number: | 4404763622 |
| Fax Number: | |
| NPI Enumeration Date: | 07/19/2006 |
| NPI Last Update Date: | 03/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | I-0000253 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |