MEDICARE: HANNAH MARCUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	178.014670	IL

General Provider Information

NPI Number	:	1477153401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH MARCUS

Provider Business Mailing Address
First Line	:	4906 N MAGNOLIA AVE APT 3E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3525
Country	:	US
Telephone Number	:	201-290-2502
Fax Number	:

Provider Business Practice Location Address
First Line	:	4809 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4495
Country	:	US
Telephone Number	:	201-290-2502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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