Provider Demographics
NPI:1639615685
Name:MARFONGELLI, MARIEL CATHERINE (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MARIEL
Middle Name:CATHERINE
Last Name:MARFONGELLI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 E 6TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-3070
Mailing Address - Country:US
Mailing Address - Phone:617-435-9004
Mailing Address - Fax:
Practice Address - Street 1:537 E 6TH ST APT 1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-3070
Practice Address - Country:US
Practice Address - Phone:617-435-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-15
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2299436283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital