Provider Demographics
NPI:1366849424
Name:PAYKUSS, MARILYN RUTH (MED, CAES)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:RUTH
Last Name:PAYKUSS
Suffix:
Gender:F
Credentials:MED, CAES
Other - Prefix:MRS
Other - First Name:MARILYN
Other - Middle Name:GREENWALD
Other - Last Name:PAYKUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CAES
Mailing Address - Street 1:10I ROESSLER RD
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6208
Mailing Address - Country:US
Mailing Address - Phone:781-932-8114
Mailing Address - Fax:
Practice Address - Street 1:10I ROESSLER RD
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6208
Practice Address - Country:US
Practice Address - Phone:781-932-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor