Provider Demographics
NPI:1558495952
Name:JOSEPH, MARCUS LAROY (MS)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:LAROY
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9171 WILSHIRE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5536
Mailing Address - Country:US
Mailing Address - Phone:424-274-0447
Mailing Address - Fax:213-515-6772
Practice Address - Street 1:9171 WILSHIRE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5536
Practice Address - Country:US
Practice Address - Phone:424-274-0447
Practice Address - Fax:213-515-6772
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1643101YM0800X, 101YP2500X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner