Healthcare Provider Details

I. General information

NPI: 1164342119
Provider Name (Legal Business Name): ROBERTO RAY MARSHALL MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 MARBLESTONE DR STE 270
WOODBRIDGE VA
22192-8328
US

IV. Provider business mailing address

12701 MARBLESTONE DR STE 270
WOODBRIDGE VA
22192-8328
US

V. Phone/Fax

Practice location:
  • Phone: 703-202-9069
  • Fax: 703-214-3159
Mailing address:
  • Phone: 703-202-9069
  • Fax: 703-214-3159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0906013335
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: