MEDICARE: MS. DOROTHY MARKS LCSW

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	1041C0700X	Clinical Social Worker	R053779	NY

General Provider Information

NPI Number	:	1134153935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOROTHY MARKS LCSW

Provider Business Mailing Address
First Line	:	9411 69TH AVE
Second Line	:	#210
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3722 82ND ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7032
Country	:	US
Telephone Number	:	718-779-1600
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/09/2007

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