MEDICARE: IRENE J MARSHALL LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MT1408	FL

General Provider Information

NPI Number	:	1720235922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE J MARSHALL LMFT

Provider Business Mailing Address
First Line	:	12323 SW 55TH ST
Second Line	:	SUITE 1003
City	:	COOPER CITY
State	:	FL
Zip	:	33330-3312
Country	:	US
Telephone Number	:	954-680-1211
Fax Number	:

Provider Business Practice Location Address
First Line	:	12323 SW 55TH ST
Second Line	:	SUITE 1003
City	:	COOPER CITY
State	:	FL
Zip	:	33330-3312
Country	:	US
Telephone Number	:	954-680-1211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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