Provider Demographics
NPI:1598215345
Name:MELISSA MARCUS PH.D. PLC
Entity Type:Organization
Organization Name:MELISSA MARCUS PH.D. PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-906-3691
Mailing Address - Street 1:8309 BANPO BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-0029
Mailing Address - Country:US
Mailing Address - Phone:561-906-3691
Mailing Address - Fax:
Practice Address - Street 1:8309 BANPO BRIDGE WAY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-0029
Practice Address - Country:US
Practice Address - Phone:561-906-3691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8495103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty