Basic Information
| Provider Information | |||||||||
| NPI: | 1881748366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | QUINCY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | BILLERCIA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784836800 | ||||||||
| FaxNumber: | 9784536767 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 E MERRIMACK ST | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784836800 | ||||||||
| FaxNumber: | 9784836767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 3941 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.