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General NPI Number Information
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NPI Number | 1619718483
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Entity Type | Individual
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Provider Name | KATIE-LEIGH MARSHALL LADC LL
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Gender | Female
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 45 SCHOOL ST STE 202
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City | BOSTON
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State | MA
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Zip | 02108-3206
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Country | US
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Telephone | 908-731-0819
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Fax |
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Provider Business Mailing Address
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Address Line | 1632 1ST AVE # 20163
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City | NEW YORK
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State | NY
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Zip | 10028-4305
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Country | US
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Telephone | 908-731-0819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20000
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License Number State | MA
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