Healthcare Provider Details

I. General information

NPI: 1457680381
Provider Name (Legal Business Name): BART SAMUEL MARKS L.C.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 CUMBERLAND ROAD
NORTH YARMOUTH ME
04097
US

IV. Provider business mailing address

PO BOX 456
YARMOUTH ME
04096-0456
US

V. Phone/Fax

Practice location:
  • Phone: 207-829-6934
  • Fax:
Mailing address:
  • Phone: 207-829-6934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC494
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: