Provider Demographics
NPI:1861937732
Name:MARCUS, MILLIE LAUREN (LMSW)
Entity type:Individual
Prefix:
First Name:MILLIE
Middle Name:LAUREN
Last Name:MARCUS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E 64TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7503
Mailing Address - Country:US
Mailing Address - Phone:917-273-5903
Mailing Address - Fax:
Practice Address - Street 1:16 E 16TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3105
Practice Address - Country:US
Practice Address - Phone:212-206-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099427104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker