Provider Demographics
NPI:1710611405
Name:MARSHALL, SANDRA HALE (RNMALADC1)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:HALE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RNMALADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 GIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02744-2610
Mailing Address - Country:US
Mailing Address - Phone:508-999-3126
Mailing Address - Fax:508-991-8409
Practice Address - Street 1:34 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02744-2610
Practice Address - Country:US
Practice Address - Phone:508-999-3126
Practice Address - Fax:508-991-8409
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA911101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)