Healthcare Provider Details

I. General information

NPI: 1932374170
Provider Name (Legal Business Name): MARCUS ARTIS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 5TH AVE 1301 5TH AVENUE
NEW YORK NY
10029-3119
US

IV. Provider business mailing address

1301 5TH AVE NORTHSIDE CENTER FOR CHILD DEVELOPMENT
NEW YORK NY
10029-3119
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-3400
  • Fax: 212-410-7561
Mailing address:
  • Phone: 212-426-3400
  • Fax: 212-410-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number078893
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: