Provider Demographics
NPI:1194832014
Name:MARSIGLIA, CHERYL S (PHD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:S
Last Name:MARSIGLIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 LINE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104
Mailing Address - Country:US
Mailing Address - Phone:318-865-7500
Mailing Address - Fax:318-868-2035
Practice Address - Street 1:2210 LINE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104
Practice Address - Country:US
Practice Address - Phone:318-865-7500
Practice Address - Fax:318-868-2035
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA950103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist