Provider Demographics
NPI:1457669962
Name:MARCUS, SARAH E (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:MARCUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1380 BENTON
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401
Mailing Address - Country:US
Mailing Address - Phone:208-523-2490
Mailing Address - Fax:208-522-2603
Practice Address - Street 1:1301 MAIN ST.
Practice Address - Street 2:SUITE 3B
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467
Practice Address - Country:US
Practice Address - Phone:208-756-2927
Practice Address - Fax:208-756-1518
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2172801041C0700X
ID329111041C0700X
IDLCSW-342441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
20005967Medicare UPIN