Provider Demographics
NPI:1669517462
Name:MARCUS PSYCHOLOGY, INC.
Entity type:Organization
Organization Name:MARCUS PSYCHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ELDRIDGE
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-666-8000
Mailing Address - Street 1:7685 SW 104TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3161
Mailing Address - Country:US
Mailing Address - Phone:305-666-8000
Mailing Address - Fax:305-666-4311
Practice Address - Street 1:7685 SW 104TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3161
Practice Address - Country:US
Practice Address - Phone:305-666-8000
Practice Address - Fax:305-666-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75024OtherBLUE CROSS BLUE SHIELD