Provider Demographics
NPI:1114411469
Name:FRANKLIN, MARJORY SPENCER (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARJORY
Middle Name:SPENCER
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5719
Mailing Address - Country:US
Mailing Address - Phone:703-228-6061
Mailing Address - Fax:
Practice Address - Street 1:855 N EDISON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-1209
Practice Address - Country:US
Practice Address - Phone:703-228-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-122403103TS0200X
VA0831000969103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0813000969OtherVA DEPT HEALTH PROFESSIONS LICENSE