Provider Demographics
NPI:1093932782
Name:KROEGER, MARJORIE PIERCE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:PIERCE
Last Name:KROEGER
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SW CUTOFF
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2135
Mailing Address - Country:US
Mailing Address - Phone:508-393-3151
Mailing Address - Fax:
Practice Address - Street 1:21 SW CUTOFF
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2135
Practice Address - Country:US
Practice Address - Phone:508-393-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health