Provider Demographics
NPI:1235651290
Name:MARSHALL, STEPHEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:MARSHALL
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:P.O. BOX 1285
Mailing Address - Street 2:
Mailing Address - City:E. ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-0021
Mailing Address - Country:US
Mailing Address - Phone:617-977-4770
Mailing Address - Fax:
Practice Address - Street 1:226 MASSACHUSETTS AVE STE 2A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8449
Practice Address - Country:US
Practice Address - Phone:617-977-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X
MA11006103TC0700X
MA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical