Provider Demographics
NPI:1811686371
Name:MARSHALL CLINICAL SOCIAL WORK
Entity type:Organization
Organization Name:MARSHALL CLINICAL SOCIAL WORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-910-7696
Mailing Address - Street 1:12335 CHERRY BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4402
Mailing Address - Country:US
Mailing Address - Phone:301-910-7696
Mailing Address - Fax:
Practice Address - Street 1:12335 CHERRY BRANCH DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-4402
Practice Address - Country:US
Practice Address - Phone:301-910-7696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)