1053728659 NPI number — MRS. ELIZABETH RENA MARSHALL MSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053728659 NPI number — MRS. ELIZABETH RENA MARSHALL MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSHALL
Provider First Name:
ELIZABETH
Provider Middle Name:
RENA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOORE
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
RENA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1053728659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 JOHNSON STREET
Provider Second Line Business Mailing Address:
RADIATION ONCOLOGY - ONCOLOGY SOCIAL WORKER
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-265-6471
Provider Business Mailing Address Fax Number:
954-985-1582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 JOHNSON STREET
Provider Second Line Business Practice Location Address:
RADIATION ONCOLOGY - ONCOLOGY SOCIAL WORKER
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-265-6471
Provider Business Practice Location Address Fax Number:
954-985-1582
Provider Enumeration Date:
07/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  ISW6810 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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