Provider Demographics
NPI:1982132841
Name:DAVIS, MARC BENJAMIN (MS, LMHC)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:BENJAMIN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 E BEECH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3718
Mailing Address - Country:US
Mailing Address - Phone:516-320-5721
Mailing Address - Fax:
Practice Address - Street 1:1 S MARION PL
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5300
Practice Address - Country:US
Practice Address - Phone:516-320-5721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY009385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health