Provider Demographics
NPI:1003446980
Name:STRAWDERMAN, MARC (EDD, BSL)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:STRAWDERMAN
Suffix:
Gender:M
Credentials:EDD, BSL
Other - Prefix:
Other - First Name:MARANATHA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 N PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3010
Mailing Address - Country:US
Mailing Address - Phone:717-560-7917
Mailing Address - Fax:717-560-6452
Practice Address - Street 1:11 SPRINT DR
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7789
Practice Address - Country:US
Practice Address - Phone:717-386-5237
Practice Address - Fax:717-386-5243
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health