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General NPI Number Information
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NPI Number | 1285760702
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Entity Type | Individual
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Provider Name | PHYLLIS C MARCUS M.S.
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 11/29/2020
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Provider Practice Location Address
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Address Line | 540 NW 165TH ST STE 110
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City | MIAMI
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State | FL
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Zip | 33169-6304
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Country | US
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Telephone | 786-648-6550
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Fax | 786-648-6505
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Provider Business Mailing Address
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Address Line | 635 SW 14TH TER APT 8
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City | FT LAUDERDALE
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State | FL
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Zip | 33312-7280
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Country | US
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Telephone | 954-304-2399
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Fax | 954-497-3857
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH9698
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT2404
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License Number State | FL
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