Provider Demographics
NPI:1720520497
Name:MARCUS, EVAN BENJAMIN (MA)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:BENJAMIN
Last Name:MARCUS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 SANTUIT NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-1337
Mailing Address - Country:US
Mailing Address - Phone:917-861-3108
Mailing Address - Fax:
Practice Address - Street 1:347 SANTUIT NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:MARSTONS MILLS
Practice Address - State:MA
Practice Address - Zip Code:02648-1337
Practice Address - Country:US
Practice Address - Phone:917-861-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-13
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health