Provider Demographics
NPI:1104393438
Name:PASTOR, MARIELLE KARINA (EDM)
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:KARINA
Last Name:PASTOR
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 BEACON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2394
Mailing Address - Country:US
Mailing Address - Phone:510-821-9587
Mailing Address - Fax:
Practice Address - Street 1:3317 DAYTON BLVD UNIT 15781
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-4764
Practice Address - Country:US
Practice Address - Phone:423-827-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health