Provider Demographics
NPI:1013173525
Name:MARSHALL, LAFAYE F (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAFAYE
Middle Name:F
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 ANNAPOLIS EXCHANGE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3271
Mailing Address - Country:US
Mailing Address - Phone:240-481-2723
Mailing Address - Fax:240-481-2723
Practice Address - Street 1:1997 ANNAPOLIS EXCHANGE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3271
Practice Address - Country:US
Practice Address - Phone:240-481-2723
Practice Address - Fax:240-481-2723
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018487103T00000X, 103TC0700X
DCPSY1000938103T00000X, 103TC0700X
VA0810005095103T00000X, 103TC0700X
MD05077103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD066736600Medicaid