Provider Demographics
NPI:1073382917
Name:SINCLAIR, MARK (LAC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SINCLAIR
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 N FRANKLIN TPKE STE 107
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2029
Mailing Address - Country:US
Mailing Address - Phone:201-749-1750
Mailing Address - Fax:
Practice Address - Street 1:79 N FRANKLIN TPKE STE 107
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2029
Practice Address - Country:US
Practice Address - Phone:201-749-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00765300101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor