Doctor Name: | MR. EUGENE CARROLL MARCERON |
NPI Number: | 1093007064 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 149009694 |
Business Practice Address: | 2025 Washington St Waukegan, IL - 600855131 |
Business Phone Number: | 8473601020 |
Business Fax Number: | 8473601065 |
Mailing Address: | 2025 Washington St, WAUKEGAN |
State: | IL |
Postal Code: | 600855131 |
Phone Number: | 8473601020 |
Fax Number: | 8473601065 |
NPI Enumeration Date: | 05/10/2011 |
NPI Last Update Date: | 05/10/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149009694 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |