Healthcare Provider Details

I. General information

NPI: 1598606733
Provider Name (Legal Business Name): BROOKE MARIE MARSHALL PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E CAVEN ST
INDIANAPOLIS IN
46225-1839
US

IV. Provider business mailing address

259 E CAVEN ST
INDIANAPOLIS IN
46225-1839
US

V. Phone/Fax

Practice location:
  • Phone: 920-619-6496
  • Fax:
Mailing address:
  • Phone: 920-619-6496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20044059A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: