Provider Demographics
NPI:1851043707
Name:STEIN-MARCUS, KELLY A
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A
Last Name:STEIN-MARCUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FOOT POINT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-0846
Mailing Address - Country:US
Mailing Address - Phone:401-595-1594
Mailing Address - Fax:
Practice Address - Street 1:1 FOOT POINT RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-0846
Practice Address - Country:US
Practice Address - Phone:401-595-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical