Provider Demographics
NPI:1376745182
Name:MARCUS, MINDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:
Last Name:MARCUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7905 N RANGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:RIVER HILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2044
Mailing Address - Country:US
Mailing Address - Phone:414-354-5060
Mailing Address - Fax:
Practice Address - Street 1:CLEMENTE J ZABLOCKI MEDICAL CTR
Practice Address - Street 2:5000 W. NATIONAL AVE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001023103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling