Provider Demographics
NPI:1871658328
Name:MARCUS, LYNN MARLENE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MARLENE
Last Name:MARCUS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2955
Mailing Address - Country:US
Mailing Address - Phone:413-533-4546
Mailing Address - Fax:413-322-8345
Practice Address - Street 1:132 MAIN ST ROUTE 9
Practice Address - Street 2:3RD FLOOR BRASSWORKS BUILDING
Practice Address - City:HAYDENVILLE
Practice Address - State:MA
Practice Address - Zip Code:01039
Practice Address - Country:US
Practice Address - Phone:413-883-6329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1107161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08224OtherBLUE CROSS BLUE SHIELD
MA32624OtherHEALTH NEW ENGLAND
MA595770000OtherMAGELLAN
MAP08224OtherBLUE CROSS BLUE SHIELD
MAP22586Medicare UPIN
MAP22586Medicare ID - Type Unspecified