Provider Demographics
NPI:1891842183
Name:MARCUS, ADELE (LICSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:
Last Name:MARCUS
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 TURKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-9705
Mailing Address - Country:US
Mailing Address - Phone:413-303-1203
Mailing Address - Fax:
Practice Address - Street 1:130 TURKEY HILL RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-9705
Practice Address - Country:US
Practice Address - Phone:413-303-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1121621041C0700X
NYR042822-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA129256OtherVALUE OPTIONS ID #
MA1854437Medicaid
NY129256OtherVALUE OPTIONS ID #
MAP08441OtherBLUE CROSS BLUE SHIELD #
MAP08441OtherBLUE CROSS BLUE SHIELD #