Provider Demographics
NPI:1659754125
Name:EAGLESON, MARCIA J (MED)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:J
Last Name:EAGLESON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:MARCIA
Other - Middle Name:J
Other - Last Name:EAGLESON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:76 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1805
Mailing Address - Country:US
Mailing Address - Phone:413-552-3805
Mailing Address - Fax:
Practice Address - Street 1:463 SWANSEA MALL DR.
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777
Practice Address - Country:US
Practice Address - Phone:413-552-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health