Provider Demographics
NPI:1003811878
Name:MARSHALL, PENELOPE (MSW)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10080 SPYGLASS HILL LN
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7971
Mailing Address - Country:US
Mailing Address - Phone:239-275-5002
Mailing Address - Fax:
Practice Address - Street 1:9220 BONITA BEACH RD
Practice Address - Street 2:STE 227
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4236
Practice Address - Country:US
Practice Address - Phone:239-293-0122
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSW 6321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPSW632OtherSTATE LICENSE
AZCSW760IMedicare PIN