| Doctor Name: | MR. RANDOLPH OWEN MARCUS |
| NPI Number: | 1053475293 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW, DSW |
| License Number: | RO18264-1 |
| Business Practice Address: | 749 Durham Rd East Meadow, NY - 115544604 |
| Business Phone Number: | 5162920976 |
| Business Fax Number: | |
| Mailing Address: | 749 Durham Rd, EAST MEADOW |
| State: | NY |
| Postal Code: | 115544604 |
| Phone Number: | 5162920976 |
| Fax Number: | |
| NPI Enumeration Date: | 12/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | RO18264-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |