Provider Demographics
NPI:1275660615
Name:MARSH, CAROL JEAN (PHD)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JEAN
Last Name:MARSH
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 1:4100 OMAO STREET
Mailing Address - Street 2:
Mailing Address - City:KOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96756-9630
Mailing Address - Country:US
Mailing Address - Phone:808-742-9733
Mailing Address - Fax:808-742-9733
Practice Address - Street 1:4100 OMAO STREET
Practice Address - Street 2:
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756-9630
Practice Address - Country:US
Practice Address - Phone:808-742-9733
Practice Address - Fax:808-742-9733
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI617103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI002411Medicaid
HI002411Medicaid
50684Medicare ID - Type Unspecified