Provider Demographics
NPI:1427182955
Name:MARSHALL, REGINA MICELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:MICELLE
Last Name:MARSHALL
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 1:30 E SAN JOAQUIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2947
Mailing Address - Country:US
Mailing Address - Phone:831-759-2540
Mailing Address - Fax:831-754-1002
Practice Address - Street 1:30 E SAN JOAQUIN ST STE 207
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2947
Practice Address - Country:US
Practice Address - Phone:831-759-2540
Practice Address - Fax:831-754-1002
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL150280Medicare UPIN