Provider Demographics
NPI:1154614717
Name:LINDA MARSH, PSY.D.,P.A.
Entity type:Organization
Organization Name:LINDA MARSH, PSY.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:207-829-4070
Mailing Address - Street 1:57 EXCHANGE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5000
Mailing Address - Country:US
Mailing Address - Phone:207-829-4070
Mailing Address - Fax:207-775-4454
Practice Address - Street 1:57 EXCHANGE ST
Practice Address - Street 2:SUITE 403
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5000
Practice Address - Country:US
Practice Address - Phone:207-829-4070
Practice Address - Fax:207-775-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1019103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME204270099Medicaid
ME204270099Medicaid