Provider Demographics
NPI:1447034459
Name:MARSHALL, AMANDA P (PHD, NCSP)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:P
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5221
Mailing Address - Country:US
Mailing Address - Phone:201-889-9292
Mailing Address - Fax:
Practice Address - Street 1:513 W MOUNT PLEASANT AVE STE 212
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1721
Practice Address - Country:US
Practice Address - Phone:201-889-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00715000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist