Provider Demographics
NPI:1467597419
Name:NEGRON, MARVIN AYALA (MA)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:AYALA
Last Name:NEGRON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MORELAND ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1041
Mailing Address - Country:US
Mailing Address - Phone:508-753-0099
Mailing Address - Fax:
Practice Address - Street 1:39 MORELAND ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1041
Practice Address - Country:US
Practice Address - Phone:508-753-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health