Provider Demographics
NPI:1073705133
Name:MARCUS, STUART L (LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:L
Last Name:MARCUS
Suffix:
Gender:M
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 W MAIN ST
Mailing Address - Street 2:STE. 1-S
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-3806
Mailing Address - Country:US
Mailing Address - Phone:618-394-9282
Mailing Address - Fax:
Practice Address - Street 1:6400 W MAIN ST
Practice Address - Street 2:STE. 1-S
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3806
Practice Address - Country:US
Practice Address - Phone:618-394-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical