MEDICARE: DR. MARCUS VAN SICKLE PH.D., ABPP, MPAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP0016X	Prescribing (Medical) Psychologist	340254	LA
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1043666506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS VAN SICKLE PH.D., ABPP, MPAP

Provider Business Mailing Address
First Line	:	9861 BROKEN LAND PKWY STE 100
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-3031
Country	:	US
Telephone Number	:	202-209-3406
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 REMOUNT RD BLDG 3107
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-3516
Country	:	US
Telephone Number	:	571-607-2055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2016
Last Update Date	:	10/24/2025

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