Provider Demographics
NPI:1699238394
Name:MARSHALL, TESHA MONIQUE
Entity type:Individual
Prefix:
First Name:TESHA
Middle Name:MONIQUE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2432
Mailing Address - Country:US
Mailing Address - Phone:609-654-9860
Mailing Address - Fax:
Practice Address - Street 1:85 UNION ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2432
Practice Address - Country:US
Practice Address - Phone:609-654-9860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health