Healthcare Provider Details

I. General information

NPI: 1427854652
Provider Name (Legal Business Name): LISA D MARQUETTE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 OAK TREE RD
MONMOUTH JCT NJ
08852-3040
US

IV. Provider business mailing address

7 OAK TREE RD
MONMOUTH JCT NJ
08852-3040
US

V. Phone/Fax

Practice location:
  • Phone: 732-236-5029
  • Fax:
Mailing address:
  • Phone: 732-236-5029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number35SI00395400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: