Healthcare Provider Details

I. General information

NPI: 1619345345
Provider Name (Legal Business Name): SARAH C MARSHALL PH D PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 SOUTH ST DOCTOR'S PARK BLDG. A
PITTSFIELD MA
01201-6893
US

IV. Provider business mailing address

197 SOUTH ST DOCTOR'S PARK BLDG. A
PITTSFIELD MA
01201-6893
US

V. Phone/Fax

Practice location:
  • Phone: 413-445-9944
  • Fax: 949-863-6452
Mailing address:
  • Phone: 413-445-9944
  • Fax: 949-863-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number7350
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8844
License Number StateMA

VIII. Authorized Official

Name: SARAH C. MARSHALL
Title or Position: DIRECTOR
Credential: PHD
Phone: 413-445-9944