Healthcare Provider Details

I. General information

NPI: 1285760702
Provider Name (Legal Business Name): PHYLLIS C MARCUS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PHYLLIS JANE CRAMER

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 11/29/2020
Certification Date: 11/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 NW 165TH ST STE 110
MIAMI FL
33169-6304
US

IV. Provider business mailing address

635 SW 14TH TER APT 8
FT LAUDERDALE FL
33312-7280
US

V. Phone/Fax

Practice location:
  • Phone: 786-648-6550
  • Fax: 786-648-6505
Mailing address:
  • Phone: 954-304-2399
  • Fax: 954-497-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9698
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: