Healthcare Provider Details

I. General information

NPI: 1093511800
Provider Name (Legal Business Name): JUSTIN WILLIAM MARSH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 N MIRANDA ST APT B3
LAS CRUCES NM
88005-2063
US

IV. Provider business mailing address

1155 N MIRANDA ST APT B3
LAS CRUCES NM
88005-2063
US

V. Phone/Fax

Practice location:
  • Phone: 413-320-8916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0266
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: