Provider Demographics
NPI:1225751878
Name:MARSHALL, MATTHEW GREER
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GREER
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 PARKVIEW LN APT 17B
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1806
Mailing Address - Country:US
Mailing Address - Phone:714-944-5665
Mailing Address - Fax:
Practice Address - Street 1:2222 MARTIN STE 170
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1450
Practice Address - Country:US
Practice Address - Phone:949-474-5577
Practice Address - Fax:949-475-5575
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
CARBT-22-230319106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other