Healthcare Provider Details

I. General information

NPI: 1184539603
Provider Name (Legal Business Name): ISAAC MARSHALL RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 KINGS HWY E STE 110
FAIRFIELD CT
06825-4859
US

IV. Provider business mailing address

1152 SHIPPAN AVE # 2
STAMFORD CT
06902-7425
US

V. Phone/Fax

Practice location:
  • Phone: 203-433-7440
  • Fax:
Mailing address:
  • Phone: 203-343-5609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-464904
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: