Provider Demographics
NPI:1730495433
Name:MARCUS, IVY APRIL
Entity type:Individual
Prefix:MS
First Name:IVY
Middle Name:APRIL
Last Name:MARCUS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:IVY
Other - Middle Name:APRIL
Other - Last Name:MARCUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC/SLP
Mailing Address - Street 1:12 BRAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1420
Mailing Address - Country:US
Mailing Address - Phone:914-472-9116
Mailing Address - Fax:
Practice Address - Street 1:12 BRAYTON RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1420
Practice Address - Country:US
Practice Address - Phone:914-472-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003736-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist