Provider Demographics
NPI:1083187298
Name:DAVIS, MARCUS DALE (MSW)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:DALE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3246 LAUREL RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-1841
Mailing Address - Country:US
Mailing Address - Phone:954-471-3160
Mailing Address - Fax:
Practice Address - Street 1:2000 W BLUE HERON BLVD
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-5010
Practice Address - Country:US
Practice Address - Phone:561-814-8997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical