Provider Demographics
NPI:1528044195
Name:MARCUS, JOEL DANIEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:DANIEL
Last Name:MARCUS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BMDA - BANNER UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:925 E. MCDOWELL RD
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006
Mailing Address - Country:US
Mailing Address - Phone:602-521-3700
Mailing Address - Fax:702-944-1185
Practice Address - Street 1:BMDA - BANNER UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:925 E. MCDOWELL RD
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-521-3700
Practice Address - Fax:216-538-6271
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1180103T00000X
TX32143103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2175700Medicaid
TX162880203Medicaid
TX162880204OtherCSHCN
MS06908019Medicaid
MS06908019Medicaid
LA2175700Medicaid