Provider Demographics
NPI:1376566919
Name:MARKS, DONNA ROSEMARY (PSYD, RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:ROSEMARY
Last Name:MARKS
Suffix:
Gender:F
Credentials:PSYD, RN
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:R
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:186 CABOT ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5846
Mailing Address - Country:US
Mailing Address - Phone:978-646-8830
Mailing Address - Fax:978-646-8862
Practice Address - Street 1:186 CABOT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5846
Practice Address - Country:US
Practice Address - Phone:978-646-8830
Practice Address - Fax:978-646-8862
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8540103G00000X, 103TC0700X, 103TH0100X
MA173060163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06489OtherBCBSMA