Provider Demographics
NPI:1093886210
Name:HARTH, MARSHALL STEPHEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:STEPHEN
Last Name:HARTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 E RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3936
Mailing Address - Country:US
Mailing Address - Phone:201-684-0942
Mailing Address - Fax:201-684-0941
Practice Address - Street 1:1172 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3936
Practice Address - Country:US
Practice Address - Phone:201-684-0942
Practice Address - Fax:201-684-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00436400103T00000X
NY005016103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist