Provider Demographics
NPI:1871555862
Name:MARCUS, CARLA A (LICSW)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:MARCUS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 452
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:RI
Mailing Address - Zip Code:02898-0452
Mailing Address - Country:US
Mailing Address - Phone:401-539-0276
Mailing Address - Fax:401-842-0360
Practice Address - Street 1:823 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE VALLEY
Practice Address - State:RI
Practice Address - Zip Code:02832-1920
Practice Address - Country:US
Practice Address - Phone:401-539-0228
Practice Address - Fax:401-842-0360
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW00724104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICM58571Medicaid
RI809003823Medicare ID - Type Unspecified