Provider Demographics
NPI:1598182727
Name:MARCUS, JUDITH ESTHER (LICSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ESTHER
Last Name:MARCUS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 WAYZATA BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1842
Mailing Address - Country:US
Mailing Address - Phone:952-542-4840
Mailing Address - Fax:952-593-1778
Practice Address - Street 1:13100 WAYZATA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1842
Practice Address - Country:US
Practice Address - Phone:952-542-4840
Practice Address - Fax:952-593-1778
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical