Provider Demographics
NPI:1285996223
Name:HODGE-MARSHALL, MONIFA INEZ (MS SPED)
Entity type:Individual
Prefix:MRS
First Name:MONIFA
Middle Name:INEZ
Last Name:HODGE-MARSHALL
Suffix:
Gender:F
Credentials:MS SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BENCHLEY PL
Mailing Address - Street 2:APT 6J, BLDG. 25
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-3302
Mailing Address - Country:US
Mailing Address - Phone:917-714-4363
Mailing Address - Fax:
Practice Address - Street 1:100 BENCHLEY PLACE
Practice Address - Street 2:APT 6J, BLDG. 25
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475
Practice Address - Country:US
Practice Address - Phone:917-714-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY795870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist