Provider Demographics
NPI:1780903534
Name:MARSHALL, JENNIFER (BCBA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 POST ROAD
Mailing Address - Street 2:#6606
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7045
Mailing Address - Country:US
Mailing Address - Phone:401-808-9256
Mailing Address - Fax:
Practice Address - Street 1:3595 POST RD
Practice Address - Street 2:#6606
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-7078
Practice Address - Country:US
Practice Address - Phone:401-808-9256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1-09-5530103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst