Healthcare Provider Details

I. General information

NPI: 1871555862
Provider Name (Legal Business Name): CARLA A. MARCUS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 MAIN ST
HOPE VALLEY RI
02832-1920
US

IV. Provider business mailing address

PO BOX 452
WYOMING RI
02898-0452
US

V. Phone/Fax

Practice location:
  • Phone: 401-539-0228
  • Fax: 401-842-0360
Mailing address:
  • Phone: 401-539-0276
  • Fax: 401-842-0360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW00724
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: