Provider Demographics
NPI:1275081440
Name:MARSHALL, YVETTE (LPC)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 208-F
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3441
Mailing Address - Country:US
Mailing Address - Phone:973-996-2667
Mailing Address - Fax:973-843-7918
Practice Address - Street 1:1955 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 208-F
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3441
Practice Address - Country:US
Practice Address - Phone:973-996-2667
Practice Address - Fax:973-843-7918
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00560900101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional