Provider Demographics
NPI:1619079324
Name:MARCUS, DALE EILEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:EILEEN
Last Name:MARCUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 GAGE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2736
Mailing Address - Country:US
Mailing Address - Phone:215-699-4333
Mailing Address - Fax:215-855-2050
Practice Address - Street 1:311 N SUMNEYTOWN PIKE STE 2A
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2530
Practice Address - Country:US
Practice Address - Phone:215-699-4333
Practice Address - Fax:215-699-0361
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005838L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA195002Medicare ID - Type UnspecifiedMEDICARE CLAIMS NUMBER