Provider Demographics
NPI:1477503753
Name:MARKS LECONEY, ROSE CINDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:CINDY
Last Name:MARKS LECONEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:R. CINDY
Other - Middle Name:
Other - Last Name:MARKS LECONEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3 MAIN ST UNIT 17
Mailing Address - Street 2:
Mailing Address - City:EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02642-2169
Mailing Address - Country:US
Mailing Address - Phone:508-247-7898
Mailing Address - Fax:
Practice Address - Street 1:3 MAIN ST UNIT 17
Practice Address - Street 2:
Practice Address - City:EASTHAM
Practice Address - State:MA
Practice Address - Zip Code:02642-2169
Practice Address - Country:US
Practice Address - Phone:508-247-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7980103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W51048Medicare ID - Type Unspecified