Provider Demographics
NPI:1255178364
Name:WRIGHT, MARCUS A (LAC)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 RIDGE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1513
Mailing Address - Country:US
Mailing Address - Phone:201-674-4054
Mailing Address - Fax:
Practice Address - Street 1:622-624 VALLEY RD STE 5G5H
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1462
Practice Address - Country:US
Practice Address - Phone:732-674-9857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00796400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health