Provider Demographics
NPI:1912965526
Name:MARSHALL, ROBERT B (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:B
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 ROOSEVELT AVENUE
Mailing Address - Street 2:SUITE 205 GATWAY HEALTHCARE INC
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860
Mailing Address - Country:US
Mailing Address - Phone:401-724-8400
Mailing Address - Fax:401-365-1100
Practice Address - Street 1:103 BACON ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5542
Practice Address - Country:US
Practice Address - Phone:401-728-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1SW00225104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRM20115Medicaid
RI407698OtherB CHIP
RI30589OtherBC
RI7065717Medicare ID - Type Unspecified