Provider Demographics
NPI:1508060799
Name:AVERY, MARSHA CAROL (PHD)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:CAROL
Last Name:AVERY
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 1:457 BAYARD RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2533
Mailing Address - Country:US
Mailing Address - Phone:610-925-3920
Mailing Address - Fax:610-925-3921
Practice Address - Street 1:104 COMMONS CT
Practice Address - Street 2:THE COMMONS AT CHADDS FORD
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9708
Practice Address - Country:US
Practice Address - Phone:610-358-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANA102L00000X
PAPS005928L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS005928LOtherPSYCHOLOGIST LICENSE