Provider Demographics
NPI:1285984344
Name:UMPIERREZ, MARIBEL ALICIA
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:ALICIA
Last Name:UMPIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S BROADWAY # 287
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3374
Mailing Address - Country:US
Mailing Address - Phone:508-507-8140
Mailing Address - Fax:
Practice Address - Street 1:215 S BROADWAY # 287
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3374
Practice Address - Country:US
Practice Address - Phone:508-507-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1251871041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical