Provider Demographics
NPI:1326324450
Name:MYRA J. MARSHALL, LPC, LLC
Entity Type:Organization
Organization Name:MYRA J. MARSHALL, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-240-2100
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2140
Mailing Address - Country:US
Mailing Address - Phone:732-240-2100
Mailing Address - Fax:732-240-2144
Practice Address - Street 1:249 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7587
Practice Address - Country:US
Practice Address - Phone:732-240-2100
Practice Address - Fax:732-240-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00074000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty