Provider Demographics
NPI:1124436423
Name:EXIL, MARIE FLORENCE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:FLORENCE
Last Name:EXIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:FLORENCE
Other - Last Name:FORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:105 RICHMOND ST # 1
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2622
Mailing Address - Country:US
Mailing Address - Phone:508-818-6044
Mailing Address - Fax:
Practice Address - Street 1:105 RICHMOND ST # 1
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2622
Practice Address - Country:US
Practice Address - Phone:508-818-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health