Provider Demographics
NPI:1164797502
Name:QUIROZ, MARCELLO
Entity Type:Individual
Prefix:MR
First Name:MARCELLO
Middle Name:
Last Name:QUIROZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 BERKELEY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6230
Mailing Address - Country:US
Mailing Address - Phone:617-668-6945
Mailing Address - Fax:617-247-1924
Practice Address - Street 1:95 BERKELEY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-6230
Practice Address - Country:US
Practice Address - Phone:617-778-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor