Provider Demographics
NPI:1528443710
Name:QUENEAU, MARIE JOSEE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:JOSEE
Last Name:QUENEAU
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 1:2906 CALADIUM CT
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2816
Mailing Address - Country:US
Mailing Address - Phone:972-481-4084
Mailing Address - Fax:
Practice Address - Street 1:2121 NORTHWEST HWY
Practice Address - Street 2:SUITE 119
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-4858
Practice Address - Country:US
Practice Address - Phone:972-414-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist