Provider Demographics
NPI:1528461340
Name:GARRAUD, MARINELLE
Entity type:Individual
Prefix:
First Name:MARINELLE
Middle Name:
Last Name:GARRAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:100 CUMMINGS CTR STE 325K
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6119
Mailing Address - Country:US
Mailing Address - Phone:978-720-8934
Mailing Address - Fax:978-969-6198
Practice Address - Street 1:MENTAL HEALTH PLUS LLC
Practice Address - Street 2:100 CUMMINGS CENTER, SUITE 325K
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-720-8934
Practice Address - Fax:978-969-6198
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256972363L00000X, 363LP0808X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1528461340Medicaid