Provider Demographics
NPI:1962061085
Name:SURUN, MARLENE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:SURUN
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 1:232 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7121
Mailing Address - Country:US
Mailing Address - Phone:978-655-1823
Mailing Address - Fax:
Practice Address - Street 1:232 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-7121
Practice Address - Country:US
Practice Address - Phone:978-655-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health