Provider Demographics
NPI:1932651833
Name:MARCUS, AMY (MSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MARCUS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SOUTHDOWN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2500
Mailing Address - Country:US
Mailing Address - Phone:631-425-2650
Mailing Address - Fax:
Practice Address - Street 1:29 SOUTHDOWN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2500
Practice Address - Country:US
Practice Address - Phone:631-425-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO26671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health