Provider Demographics
NPI:1639338197
Name:WASZCZUK MARSHALL, AGNIESZKA (PSY D)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:WASZCZUK MARSHALL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E. OCEAN BOULEVARD, SUITE 250-F
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-242-9950
Mailing Address - Fax:772-220-3484
Practice Address - Street 1:900 E OCEAN BLVD SUITE 250-F
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-242-9950
Practice Address - Fax:772-220-3484
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7689103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist