MEDICARE: BART SAMUEL MARKS L.C.P.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	101YP2500X	Professional Counselor	CC494	ME

General Provider Information

NPI Number	:	1457680381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BART SAMUEL MARKS L.C.P.C.

Provider Business Mailing Address
First Line	:	PO BOX 456
Second Line	:
City	:	YARMOUTH
State	:	ME
Zip	:	04096-0456
Country	:	US
Telephone Number	:	207-829-6934
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 CUMBERLAND ROAD
Second Line	:
City	:	NORTH YARMOUTH
State	:	ME
Zip	:	04097
Country	:	US
Telephone Number	:	207-829-6934
Fax Number	:

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

Provider Enumeration Date	:	12/24/2009
Last Update Date	:	12/24/2009

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