Provider Demographics
NPI:1225596927
Name:MARRERO, EVELYN
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:MARRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:MARRERO MIRANDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:235 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5117
Mailing Address - Country:US
Mailing Address - Phone:413-532-0389
Mailing Address - Fax:413-534-3238
Practice Address - Street 1:235 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5117
Practice Address - Country:US
Practice Address - Phone:413-532-0389
Practice Address - Fax:413-534-3238
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health