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NPI Code Detail

MEDICARE: MICHELE MARSHALL

MEDICARE: MICHELE MARSHALL
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
1320800000XMental Illness Community Based Residential Treatment Facility101YM0800XNJ
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1972918860
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE MARSHALL
Provider Business Mailing Address
First Line : 1708 65TH AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19126-3412
Country : US
Telephone Number : 856-343-2565
Fax Number :
Provider Business Practice Location Address
First Line : 110 CHURCH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19106-2201
Country : US
Telephone Number : 55-026-7807
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2014
Last Update Date : 07/25/2025

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Directions to “ MICHELE MARSHALL ” Practice Location

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