Provider Demographics
NPI:1104930247
Name:MARKS, ERIK (LICSW)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:MARKS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 MASS AVE
Mailing Address - Street 2:SUITE 2-1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3073
Mailing Address - Country:US
Mailing Address - Phone:617-448-9916
Mailing Address - Fax:855-739-4903
Practice Address - Street 1:872 MASS AVE
Practice Address - Street 2:SUITE 2-1
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3073
Practice Address - Country:US
Practice Address - Phone:617-448-9916
Practice Address - Fax:855-739-4903
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1108821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1859374Medicaid
MA1859374Medicaid