Provider Demographics
NPI:1265644132
Name:MARCUM, TRUDY (BSW LSW)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:
Last Name:MARCUM
Suffix:
Gender:F
Credentials:BSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6185 HUNTLEY RD STE L
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1094
Mailing Address - Country:US
Mailing Address - Phone:614-839-7276
Mailing Address - Fax:
Practice Address - Street 1:6185 HUNTLEY RD STE L
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1094
Practice Address - Country:US
Practice Address - Phone:614-854-0944
Practice Address - Fax:614-854-0947
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 0021651104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker