Provider Demographics
NPI:1598320301
Name:MARCHANT, MEGAN RENE'
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENE'
Last Name:MARCHANT
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 1:202 HIGHLAND AVE APT 20
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1529
Mailing Address - Country:US
Mailing Address - Phone:229-944-3179
Mailing Address - Fax:
Practice Address - Street 1:370 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1788
Practice Address - Country:US
Practice Address - Phone:978-620-0290
Practice Address - Fax:978-688-0531
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health