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General NPI Number Information
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NPI Number | 1215420963
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Entity Type | Organization
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Legal Business Name | MARKET STREET PSYCHOTHERAPY, P S
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 2208 NW MARKET ST STE 513
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City | SEATTLE
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State | WA
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Zip | 98107-4098
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Country | US
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Telephone | 206-403-1374
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Fax | 206-844-2337
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Provider Business Mailing Address
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Address Line | 2208 NW MARKET ST STE 513
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City | SEATTLE
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State | WA
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Zip | 98107-4098
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Country | US
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Telephone | 206-403-1374
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Fax | 206-844-2337
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. JACOB JEREMY MARKOVITZ
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Credential | MD
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Telephone | 206-403-1374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD60484101
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License Number State | WA
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