Provider Demographics
NPI:1053728659
Name:MARSHALL, ELIZABETH RENA (MSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:RENA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:RENA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3501 JOHNSON STREET
Mailing Address - Street 2:RADIATION ONCOLOGY - ONCOLOGY SOCIAL WORKER
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-265-6471
Mailing Address - Fax:954-985-1582
Practice Address - Street 1:3501 JOHNSON STREET
Practice Address - Street 2:RADIATION ONCOLOGY - ONCOLOGY SOCIAL WORKER
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-265-6471
Practice Address - Fax:954-985-1582
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW68101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical