| Doctor Name: | DR. JEFF MARINKO-SHRIVERS |
| NPI Number: | 1316166499 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | |
| Business Practice Address: | 7852 Holderman St Lewis Center, OH - 430356004 |
| Business Phone Number: | 6143062716 |
| Business Fax Number: | 7405480702 |
| Mailing Address: | 7852 Holderman St, LEWIS CENTER |
| State: | OH |
| Postal Code: | 430356004 |
| Phone Number: | 6143062716 |
| Fax Number: | 7405480702 |
| NPI Enumeration Date: | 04/25/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |