Provider Demographics
NPI:1306388855
Name:ROWELL, MARYELLEN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:ROWELL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2441
Mailing Address - Country:US
Mailing Address - Phone:781-424-0853
Mailing Address - Fax:
Practice Address - Street 1:480 FERRY ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2441
Practice Address - Country:US
Practice Address - Phone:781-424-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst