Provider Demographics
NPI:1578007134
Name:GARRIGUS, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GARRIGUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WATER ST
Mailing Address - Street 2:APT 806
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6221
Mailing Address - Country:US
Mailing Address - Phone:978-888-8812
Mailing Address - Fax:
Practice Address - Street 1:1 WATER ST
Practice Address - Street 2:APT 806
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6221
Practice Address - Country:US
Practice Address - Phone:978-888-8812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst