Provider Demographics
NPI:1568089498
Name:UPSHUR, MARION
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:UPSHUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HENDRICK ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-5216
Mailing Address - Country:US
Mailing Address - Phone:857-246-3018
Mailing Address - Fax:
Practice Address - Street 1:32 HENDRICK ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-5216
Practice Address - Country:US
Practice Address - Phone:857-246-3018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker