Provider Demographics
NPI:1699078816
Name:KIDER, MARSHAL ISSOY
Entity type:Individual
Prefix:DR
First Name:MARSHAL
Middle Name:ISSOY
Last Name:KIDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 FORUM PL BLDG 400
Mailing Address - Street 2:SUITE SUITE D&E
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2319
Mailing Address - Country:US
Mailing Address - Phone:561-616-8411
Mailing Address - Fax:561-616-8412
Practice Address - Street 1:1551 FORUM PL
Practice Address - Street 2:BUILDING 400 SUITES D&E
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2319
Practice Address - Country:US
Practice Address - Phone:561-616-8411
Practice Address - Fax:561-616-8412
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101M0800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health