Provider Demographics
NPI:1861418428
Name:LULL, MARSHA K (MSW)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:K
Last Name:LULL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:K
Other - Last Name:BARLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:18001 N 79TH AVE
Mailing Address - Street 2:SUITE C 53
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8388
Mailing Address - Country:US
Mailing Address - Phone:623-979-1616
Mailing Address - Fax:623-979-2529
Practice Address - Street 1:18001 N 79TH AVE
Practice Address - Street 2:SUITE C 53
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8388
Practice Address - Country:US
Practice Address - Phone:623-979-1616
Practice Address - Fax:623-979-2529
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 06451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical