Provider Demographics
NPI:1619718483
Name:MARSHALL, KATIE-LEIGH (LADC LL)
Entity type:Individual
Prefix:MRS
First Name:KATIE-LEIGH
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LADC LL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 1ST AVE # 20163
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4305
Mailing Address - Country:US
Mailing Address - Phone:908-731-0819
Mailing Address - Fax:
Practice Address - Street 1:45 SCHOOL ST STE 202
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-3206
Practice Address - Country:US
Practice Address - Phone:908-731-0819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)