Healthcare Provider Details

I. General information

NPI: 1134153935
Provider Name (Legal Business Name): DOROTHY MARKS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 82ND ST
JACKSON HEIGHTS NY
11372-7032
US

IV. Provider business mailing address

9411 69TH AVE #210
FOREST HILLS NY
11375-5801
US

V. Phone/Fax

Practice location:
  • Phone: 718-779-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR053779
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: