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General NPI Number Information
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NPI Number | 1396249181
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Entity Type | Organization
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Legal Business Name | MARSHALL PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 2502 URBANA PIKE
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City | IJAMSVILLE
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State | MD
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Zip | 21754-8602
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Country | US
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Telephone | 301-691-4133
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Fax |
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Provider Business Mailing Address
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Address Line | 6340 MEADOW RD
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City | FREDERICK
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State | MD
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Zip | 21701-6718
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Country | US
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Telephone | 301-691-4133
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | CASSANDRA MARSHALL
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Credential | LCSW-C
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Telephone | 301-691-4133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 17021
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License Number State | MD
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