Provider Demographics
NPI:1134780257
Name:TAYLOR-MARSHALL, NIA
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:
Last Name:TAYLOR-MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 EVERGREEN PL STE 200B
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2114
Mailing Address - Country:US
Mailing Address - Phone:973-580-4277
Mailing Address - Fax:
Practice Address - Street 1:60 EVERGREEN PL STE 200B
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2114
Practice Address - Country:US
Practice Address - Phone:973-580-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00096500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568608305OtherISSUER