Provider Demographics
NPI:1699962605
Name:MARCUS, DEBRA ELLEN (MFT)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ELLEN
Last Name:MARCUS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 POWELL ST
Mailing Address - Street 2:SUITE 2-C
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2600
Mailing Address - Country:US
Mailing Address - Phone:510-428-9660
Mailing Address - Fax:510-428-0661
Practice Address - Street 1:1240 POWELL ST
Practice Address - Street 2:2-C
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2600
Practice Address - Country:US
Practice Address - Phone:510-428-9660
Practice Address - Fax:510-428-0661
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist