Provider Demographics
NPI:1790895233
Name:MARX, THOMAS DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DAVID
Last Name:MARX
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4848 S 76TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4361
Mailing Address - Country:US
Mailing Address - Phone:414-325-7741
Mailing Address - Fax:414-325-7735
Practice Address - Street 1:4848 S 76TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4361
Practice Address - Country:US
Practice Address - Phone:414-325-7741
Practice Address - Fax:414-325-7735
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI594057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39057300Medicaid