Charisse Eudella Marshall, DSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

062663 Issued in NY

Practice address

25 W 132ND St Apt 10M
New York, NY 10037-3205

Phone

(917) 689-6795

NPI assigned

Jul 27, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brooklyn Plaza Medical Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Brooklyn, NY
  • NPI 1336113398

  Single Specialty

  Medicare reassignment NPD
• Whitman Ingersoll Farragut Health Center

  • Federally Qualified Health Center (FQHC)
  • Brooklyn, NY
  • NPI 1619366978

  Single Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1124791017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 W 132ND ST APT 10M",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100373205",
            "telephone_number": "917-689-6795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 W 132ND ST APT 10M",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100373205",
            "telephone_number": "917-689-6795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "CHARISSE",
        "middle_name": "EUDELLA",
        "name_prefix": "Dr.",
        "credential": "DSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-27",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "062663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE DRIVERS LICENSE",
            "identifier": "824142206",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "marshac1@stjohns.edu",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "25 W 132nd St Apt 10M",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100373205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Allison Anne Marshall, MD
• Annette Marshall, LMT
• Benjamin Marshall
• Benjamin Eran Marshall, MD
• Cameron Marshall, M.D.
• Christina Marshall, MD
• Christine Margit Marshall, NP
• Deborah Marshall, MD
• Delvourt Ceyon Marshall, P.T.A
• Donielle Marshall

• Clinical Social Worker in New York, NY
• Providers in New York, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.