Provider Demographics
NPI:1154474690
Name:MADDUX, MARCUS (LCSW)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:MADDUX
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:ROY
Other - Middle Name:MARK
Other - Last Name:MADDUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSCW
Mailing Address - Street 1:4851 INDEPENDENCE ST # 1000
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6715
Mailing Address - Country:US
Mailing Address - Phone:303-425-0300
Mailing Address - Fax:
Practice Address - Street 1:4851 INDEPENDENCE ST # 1000
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6715
Practice Address - Country:US
Practice Address - Phone:303-425-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099247001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000200241OtherBLUE SHIELD