Provider Demographics
NPI:1952317950
Name:CAPLAN, MARC ALLAN (PHD PA)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALLAN
Last Name:CAPLAN
Suffix:
Gender:M
Credentials:PHD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-0249
Mailing Address - Country:US
Mailing Address - Phone:575-526-4222
Mailing Address - Fax:575-526-4228
Practice Address - Street 1:637 N ALAMEDA BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2129
Practice Address - Country:US
Practice Address - Phone:575-526-4222
Practice Address - Fax:575-526-4228
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM279103TC1900X, 103TF0200X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN8388Medicaid
NMN8388Medicaid
NM343705901Medicare PIN