Provider Demographics
NPI:1346963709
Name:ULLMAN, MARC JOSEPH (MSW, LSW)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:JOSEPH
Last Name:ULLMAN
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 FRONTAGE RD APT 1302
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2216
Mailing Address - Country:US
Mailing Address - Phone:732-261-0590
Mailing Address - Fax:
Practice Address - Street 1:1900 FRONTAGE RD APT 1302
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2216
Practice Address - Country:US
Practice Address - Phone:732-261-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05777100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker