MEDICARE: MARK PAUL LICSW

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	101YM0800X	Mental Health Counselor	1027531	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083817001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK PAUL LICSW

Provider Business Mailing Address
First Line	:	319 BEECH ST
Second Line	:
City	:	HOLYOKE
State	:	MA
Zip	:	01040-3968
Country	:	US
Telephone Number	:	413-540-1155
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 BEECH ST
Second Line	:
City	:	HOLYOKE
State	:	MA
Zip	:	01040-3968
Country	:	US
Telephone Number	:	413-540-1155
Fax Number	:

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	12/10/2015

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Directions to “ MARK PAUL LICSW” Practice Location

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