Provider Demographics
NPI:1386149136
Name:FRYE-MOQUIN, MARSHA MARIE (RN, MSW, LICSW, CCM)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:MARIE
Last Name:FRYE-MOQUIN
Suffix:
Gender:F
Credentials:RN, MSW, LICSW, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:GT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1796
Mailing Address - Country:US
Mailing Address - Phone:413-854-9636
Mailing Address - Fax:413-854-9897
Practice Address - Street 1:29 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:GT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1796
Practice Address - Country:US
Practice Address - Phone:413-854-9636
Practice Address - Fax:413-854-9897
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1027631104100000X
MARN186063163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No104100000XBehavioral Health & Social Service ProvidersSocial Worker