Provider Demographics
NPI:1336291509
Name:MARKS, BETH SANDRA (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:SANDRA
Last Name:MARKS
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 TWIN ARCH RD.
Mailing Address - Street 2:
Mailing Address - City:ROCK TAVERN
Mailing Address - State:NY
Mailing Address - Zip Code:12575-5324
Mailing Address - Country:US
Mailing Address - Phone:845-427-9049
Mailing Address - Fax:845-427-2704
Practice Address - Street 1:617 TWIN ARCH RD.
Practice Address - Street 2:
Practice Address - City:ROCK TAVERN
Practice Address - State:NY
Practice Address - Zip Code:12575-5324
Practice Address - Country:US
Practice Address - Phone:845-427-9049
Practice Address - Fax:845-427-2704
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR02857611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0053456OtherGHI BILLING VALUE OPTIONS
NY124044OtherEMPIRE PLAN VALUE OPTIONS
NY6209241Medicare ID - Type Unspecified