Provider Demographics
NPI:1215301056
Name:MARSH, VERNITA A (PHD)
Entity type:Individual
Prefix:DR
First Name:VERNITA
Middle Name:A
Last Name:MARSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 GRAND AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-5054
Mailing Address - Country:US
Mailing Address - Phone:510-420-4555
Mailing Address - Fax:510-225-0177
Practice Address - Street 1:401 GRAND AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-5054
Practice Address - Country:US
Practice Address - Phone:510-420-4555
Practice Address - Fax:510-225-0177
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16003103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY16003OtherBOARD OF PSYCHOLOGY