MEDICARE: MRS. BETH SANDRA MARKS LCSWR

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	R0285761	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0053456	OTHER	NY	GHI BILLING VALUE OPTIONS
2	124044	OTHER	NY	EMPIRE PLAN VALUE OPTIONS

General Provider Information

NPI Number	:	1336291509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH SANDRA MARKS LCSWR

Provider Business Mailing Address
First Line	:	617 TWIN ARCH RD.
Second Line	:
City	:	ROCK TAVERN
State	:	NY
Zip	:	12575-5324
Country	:	US
Telephone Number	:	845-427-9049
Fax Number	:	845-427-2704

Provider Business Practice Location Address
First Line	:	617 TWIN ARCH RD.
Second Line	:
City	:	ROCK TAVERN
State	:	NY
Zip	:	12575-5324
Country	:	US
Telephone Number	:	845-427-9049
Fax Number	:	845-427-2704

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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