Provider Demographics
NPI:1457680381
Name:MARKS, BART SAMUEL (LCPC)
Entity Type:Individual
Prefix:
First Name:BART
Middle Name:SAMUEL
Last Name:MARKS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-0456
Mailing Address - Country:US
Mailing Address - Phone:207-829-6934
Mailing Address - Fax:
Practice Address - Street 1:146 CUMBERLAND ROAD
Practice Address - Street 2:
Practice Address - City:NORTH YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04097
Practice Address - Country:US
Practice Address - Phone:207-829-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC494101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional