Provider Demographics
NPI:1336326271
Name:MARSH, KEVIN JAMES (LICENSED CLINICAL PR)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:MARSH
Suffix:
Gender:M
Credentials:LICENSED CLINICAL PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MILL LANE
Mailing Address - Street 2:
Mailing Address - City:CRISFIELD
Mailing Address - State:MD
Mailing Address - Zip Code:21817
Mailing Address - Country:US
Mailing Address - Phone:410-968-0569
Mailing Address - Fax:410-968-3690
Practice Address - Street 1:19 MILL LANE
Practice Address - Street 2:
Practice Address - City:CRISFIELD
Practice Address - State:MD
Practice Address - Zip Code:21817
Practice Address - Country:US
Practice Address - Phone:410-968-0569
Practice Address - Fax:410-968-3690
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1689101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional