Provider Demographics
NPI:1598817041
Name:BASS, MARCUS LEE (MSS LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:LEE
Last Name:BASS
Suffix:
Gender:M
Credentials:MSS LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 BRIDGETON PIKE
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1916
Mailing Address - Country:US
Mailing Address - Phone:856-464-0100
Mailing Address - Fax:856-464-0100
Practice Address - Street 1:295 BRIDGETON PIKE
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:NJ
Practice Address - Zip Code:08051-1916
Practice Address - Country:US
Practice Address - Phone:856-464-0100
Practice Address - Fax:856-464-0100
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC005318001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
4259584OtherAETNA