Provider Demographics
NPI:1154526234
Name:CANICK, MARSHA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:
Last Name:CANICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DUNCKLEE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1114
Mailing Address - Country:US
Mailing Address - Phone:617-969-1252
Mailing Address - Fax:
Practice Address - Street 1:11 DUNCKLEE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1114
Practice Address - Country:US
Practice Address - Phone:617-969-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7133103TC0700X
MA152878103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool