Provider Demographics
NPI:1386780815
Name:MARSHALL, MYRA J (PHD)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:J
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-0328
Mailing Address - Country:US
Mailing Address - Phone:732-581-0504
Mailing Address - Fax:732-237-2821
Practice Address - Street 1:1163 ROUTE 37 W
Practice Address - Street 2:BUILDING C SUITE 1
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4973
Practice Address - Country:US
Practice Address - Phone:732-581-0504
Practice Address - Fax:732-237-2821
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPC0740101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional