Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | MA | |
Y | 103T00000X | Psychologist | MA | |
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103G00000X | Clinical Psychologist | 11006 | MA |
N | 103TC0700X | Clinical Psychologist | 11006 | MA |
NPI | 1235651290 |
---|---|
Provider Name | Dr. Stephen Marshall |
First Address | E. Arlington, MA 02474-0021 |
Second Address | Arlington, MA 02474-8449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2017 |
Last Update Date | 05/06/2021 |