Provider Demographics
NPI:1396020228
Name:MARSHALL, VANESSA (LICSW,LCSW-C,LCSW)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LICSW,LCSW-C,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12002 HUNTERTON ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1614
Mailing Address - Country:US
Mailing Address - Phone:301-537-6964
Mailing Address - Fax:
Practice Address - Street 1:12002 HUNTERTON ST
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1614
Practice Address - Country:US
Practice Address - Phone:301-537-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50079066103TF0000X, 1041C0700X, 103TC2200X
MD16909106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent