Provider Demographics
NPI:1154383586
Name:MARCUS, LESLIE (MS RN CS)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MARCUS
Suffix:
Gender:F
Credentials:MS RN CS
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:JOYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RN CS
Mailing Address - Street 1:20 LEWIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:GT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-528-1845
Mailing Address - Fax:413-528-3667
Practice Address - Street 1:20 LEWIS AVENUE
Practice Address - Street 2:
Practice Address - City:GT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230
Practice Address - Country:US
Practice Address - Phone:413-528-1845
Practice Address - Fax:413-528-3667
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158658163WP0808X
NY466986163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAN50267Medicare ID - Type Unspecified