Provider Demographics
NPI:1154494193
Name:MARCUM, VICKI ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:ELIZABETH
Last Name:MARCUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6812 CLAREMONT ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102-1157
Mailing Address - Country:US
Mailing Address - Phone:815-997-3225
Mailing Address - Fax:815-965-4732
Practice Address - Street 1:11447 2ND ST
Practice Address - Street 2:9B
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-9522
Practice Address - Country:US
Practice Address - Phone:815-997-3225
Practice Address - Fax:815-965-4732
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490080671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL277753OtherCOMPPSYCH