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General NPI Number Information
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NPI Number | 1134586381
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Entity Type | Individual
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Provider Name | WAYNE MARCUS LMSW
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Gender | Male
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 31 REGENT DR
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City | LIDO BEACH
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State | NY
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Zip | 11561-4922
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Country | US
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Telephone | 917-674-0818
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Fax |
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Provider Business Mailing Address
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Address Line | 409 SMITH ST #4
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City | PEEKSKILL
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State | NY
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Zip | 10566-4541
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Country | US
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Telephone | 917-674-0818
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 050105-1
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License Number State | NY
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