Provider Demographics
NPI:1770971293
Name:HANCOCK-MARSH, JUSTINE (MA, MT-BC)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:HANCOCK-MARSH
Suffix:
Gender:F
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 DEN HELDER DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-0700
Mailing Address - Country:US
Mailing Address - Phone:209-406-9172
Mailing Address - Fax:
Practice Address - Street 1:2216 DEN HELDER DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-0700
Practice Address - Country:US
Practice Address - Phone:209-406-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07997225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist