MEDICARE: ERIC MARSH L.M.H.C.

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	004111	NY

General Provider Information

NPI Number	:	1124441704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC MARSH L.M.H.C.

Provider Business Mailing Address
First Line	:	10420 QUEENS BLVD
Second Line	:	20T
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3629
Country	:	US
Telephone Number	:	516-647-0476
Fax Number	:

Provider Business Practice Location Address
First Line	:	5628 MARATHON PKWY
Second Line	:	2I
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-2011
Country	:	US
Telephone Number	:	516-647-0476
Fax Number	:

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

Provider Enumeration Date	:	02/01/2014
Last Update Date	:	06/06/2016

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