Provider Demographics
NPI:1821589060
Name:OUELLETTE, MARINIEVES
Entity type:Individual
Prefix:MRS
First Name:MARINIEVES
Middle Name:
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARINIEVES
Other - Middle Name:
Other - Last Name:DEL VALLE PICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 ASYLUM ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2203
Mailing Address - Country:US
Mailing Address - Phone:508-488-2200
Mailing Address - Fax:508-634-3057
Practice Address - Street 1:25 BIRCH ST STE 250
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:774-804-3376
Practice Address - Fax:508-634-4345
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst