Provider Demographics
NPI:1376829101
Name:MARKS, AMITA SANTRA (PHD)
Entity Type:Individual
Prefix:
First Name:AMITA
Middle Name:SANTRA
Last Name:MARKS
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 1:3512 QUENTIN RD
Mailing Address - Street 2:STE 110
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4231
Mailing Address - Country:US
Mailing Address - Phone:800-275-3243
Mailing Address - Fax:
Practice Address - Street 1:3512 QUENTIN RD
Practice Address - Street 2:STE 110
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4231
Practice Address - Country:US
Practice Address - Phone:800-275-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018369-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical