Provider Demographics
NPI:1710084785
Name:MARSHALL, ANNE OVERTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:OVERTON
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 1:6355 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1371
Mailing Address - Country:US
Mailing Address - Phone:510-220-0808
Mailing Address - Fax:510-526-2769
Practice Address - Street 1:6355 TELEGRAPH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1371
Practice Address - Country:US
Practice Address - Phone:510-220-0808
Practice Address - Fax:510-526-2769
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15891103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical