Healthcare Provider Details

I. General information

NPI: 1700099124
Provider Name (Legal Business Name): CHERI L MARMAROSH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 CONNECTICUT AVENUE
WASHINGTON DC
20008
US

IV. Provider business mailing address

8901 GARDEN STONE LANE
FAIRFAX VA
22031
US

V. Phone/Fax

Practice location:
  • Phone: 301-718-0444
  • Fax:
Mailing address:
  • Phone: 703-573-5377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1931
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number03456
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: