Provider Demographics
NPI:1316297195
Name:MARQUIS, MICHELE MINNUCCI
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:MINNUCCI
Last Name:MARQUIS
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 1:37 TRILLIAM RUN
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-3101
Mailing Address - Country:US
Mailing Address - Phone:774-276-0540
Mailing Address - Fax:
Practice Address - Street 1:197 W 8TH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2808
Practice Address - Country:US
Practice Address - Phone:617-539-2443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MALMHC5000589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health