Provider Demographics
NPI:1982822581
Name:MARSHALL, EDWARD S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:S
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 PEARL ST STE 204
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4809
Mailing Address - Country:US
Mailing Address - Phone:303-587-8767
Mailing Address - Fax:720-523-0288
Practice Address - Street 1:8515 PEARL ST STE 204
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4809
Practice Address - Country:US
Practice Address - Phone:303-587-8767
Practice Address - Fax:303-781-7721
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2487103TF0200X, 103TP2701X, 103TR0400X, 103TC0700X, 103G00000X, 103TB0200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC810746Medicare PIN