Provider Demographics
NPI:1467502161
Name:MARSHALL, FREDERICK JOSEPH III (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOSEPH
Last Name:MARSHALL
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27796 WESTCOTT CRESCENT CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5352
Mailing Address - Country:US
Mailing Address - Phone:248-872-5477
Mailing Address - Fax:248-477-5773
Practice Address - Street 1:27796 WESTCOTT CRESCENT CIR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5352
Practice Address - Country:US
Practice Address - Phone:248-872-5477
Practice Address - Fax:248-477-5773
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002904103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68OF37073OtherBLUE CROSS BLUE SHIELD MI
MIF37073005Medicare ID - Type Unspecified