Provider Demographics
NPI:1811463656
Name:GARRIDO-BALANZATEGUI, MARCUS JOSEPH
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:JOSEPH
Last Name:GARRIDO-BALANZATEGUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 N 40TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4618
Mailing Address - Country:US
Mailing Address - Phone:305-588-5441
Mailing Address - Fax:
Practice Address - Street 1:4040 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3003
Practice Address - Country:US
Practice Address - Phone:215-895-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health