Provider Demographics
NPI:1003397969
Name:MARCUS, JENNIFER MAE (LICSW, CCM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MAE
Last Name:MARCUS
Suffix:
Gender:F
Credentials:LICSW, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1669
Mailing Address - Country:US
Mailing Address - Phone:413-478-9915
Mailing Address - Fax:
Practice Address - Street 1:96 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1669
Practice Address - Country:US
Practice Address - Phone:413-478-9915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118382104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker