Provider Demographics
NPI:1336831981
Name:MARCUS, SAMUEL STEVEN (RMHCI)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:STEVEN
Last Name:MARCUS
Suffix:
Gender:M
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6619 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-6067
Mailing Address - Country:US
Mailing Address - Phone:941-400-2877
Mailing Address - Fax:
Practice Address - Street 1:3653 CORTEZ RD W STE 110D
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3168
Practice Address - Country:US
Practice Address - Phone:941-840-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health