Provider Demographics
NPI:1720027006
Name:MARSHALL, GEORGE (LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISPORT
Mailing Address - State:KY
Mailing Address - Zip Code:42351-2526
Mailing Address - Country:US
Mailing Address - Phone:270-295-6452
Mailing Address - Fax:270-295-6450
Practice Address - Street 1:1210 4TH ST
Practice Address - Street 2:
Practice Address - City:LEWISPORT
Practice Address - State:KY
Practice Address - Zip Code:42351-2526
Practice Address - Country:US
Practice Address - Phone:270-295-6452
Practice Address - Fax:270-295-6450
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11574926OtherCAQH
KY000000175357OtherANTHEM
KY263895OtherTRICARE
KY30605018Medicaid
KY0358867Medicare PIN
KY0762226Medicare ID - Type UnspecifiedMEDICARE
KY263895OtherTRICARE
KY30605018Medicaid
KY0390915Medicare ID - Type UnspecifiedMEDICARE
KY0763523Medicare ID - Type UnspecifiedMEDICARE
KY0359264Medicare ID - Type UnspecifiedMEDICARE
KY0358967Medicare ID - Type UnspecifiedMEDICARE
KY0358867Medicare PIN
KY0358765Medicare ID - Type UnspecifiedMEDICARE