MEDICARE: PHYLLIS C MARCUS M.S.

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	MH9698	FL
2	106H00000X	Marriage & Family Therapist	MT2404	FL

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	:	1285760702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS C MARCUS M.S.

Provider Business Mailing Address
First Line	:	635 SW 14TH TER APT 8
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-7280
Country	:	US
Telephone Number	:	954-304-2399
Fax Number	:	954-497-3857

Provider Business Practice Location Address
First Line	:	540 NW 165TH ST STE 110
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-6304
Country	:	US
Telephone Number	:	786-648-6550
Fax Number	:	786-648-6505

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	11/29/2020

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Directions to “ PHYLLIS C MARCUS M.S.” Practice Location

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