Provider Demographics
NPI:1194886606
Name:MARCUS, SHIRLEY LADEN (LMFT)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:LADEN
Last Name:MARCUS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MCCORMICK AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010
Mailing Address - Country:US
Mailing Address - Phone:831-464-7479
Mailing Address - Fax:
Practice Address - Street 1:5905 SOQUEL DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073
Practice Address - Country:US
Practice Address - Phone:831-476-7879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist