Provider Demographics
NPI:1427364546
Name:PAQUETTE, MARILYN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:PAQUETTE
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 1:730 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3625
Mailing Address - Country:US
Mailing Address - Phone:602-241-6656
Mailing Address - Fax:602-241-7506
Practice Address - Street 1:730 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3625
Practice Address - Country:US
Practice Address - Phone:602-241-6656
Practice Address - Fax:602-241-7506
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC2396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional