Provider Demographics
NPI:1154656510
Name:LISTOKIN, MARC Z (BCBA)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:Z
Last Name:LISTOKIN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 E LANCASTER AVE APT 410
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2230
Mailing Address - Country:US
Mailing Address - Phone:610-896-5507
Mailing Address - Fax:610-642-6091
Practice Address - Street 1:346 E LANCASTER AVE APT 410
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2230
Practice Address - Country:US
Practice Address - Phone:610-896-5507
Practice Address - Fax:610-642-6091
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
PA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst