Healthcare Provider Details

I. General information

NPI: 1699922500
Provider Name (Legal Business Name): MARCIA K EMANUEL ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WALNUT ST
GREENVILLE OH
45331-1944
US

IV. Provider business mailing address

600 WALNUT ST
GREENVILLE OH
45331-1944
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-6842
  • Fax: 937-548-8938
Mailing address:
  • Phone: 937-548-6842
  • Fax: 937-548-8938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1732
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: