Provider Demographics
NPI:1235235250
Name:CHAMPAGNE, MARKLYN PERRY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MARKLYN
Middle Name:PERRY
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PEIRCE ST
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3833
Mailing Address - Country:US
Mailing Address - Phone:401-886-0821
Mailing Address - Fax:401-886-0693
Practice Address - Street 1:126 PEIRCE ST
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3833
Practice Address - Country:US
Practice Address - Phone:401-886-0821
Practice Address - Fax:401-886-0693
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW000601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical