Provider Demographics
NPI:1184894115
Name:FERDINAND, MARCUS A (ACSW)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:A
Last Name:FERDINAND
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 WINDING LN
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-7116
Mailing Address - Country:US
Mailing Address - Phone:575-518-9092
Mailing Address - Fax:
Practice Address - Street 1:2818 WINDING LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-7116
Practice Address - Country:US
Practice Address - Phone:575-518-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA108063104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator