Provider Demographics
NPI:1407391022
Name:MCINTOSH, MARVA
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-0723
Mailing Address - Country:US
Mailing Address - Phone:973-330-8488
Mailing Address - Fax:
Practice Address - Street 1:112 ARBOR DR
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-5050
Practice Address - Country:US
Practice Address - Phone:609-337-5447
Practice Address - Fax:609-337-5021
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103TM1800X
385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities