Healthcare Provider Details

I. General information

NPI: 1881748366
Provider Name (Legal Business Name): JOHN QUINCY MARSHALL JR. LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 E MERRIMACK ST
LOWELL MA
01852
US

IV. Provider business mailing address

1 CONCORD RD
BILLERCIA MA
01821
US

V. Phone/Fax

Practice location:
  • Phone: 978-483-6800
  • Fax: 978-483-6767
Mailing address:
  • Phone: 978-483-6800
  • Fax: 978-453-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3941
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: