Provider Demographics
NPI:1679024053
Name:TURGEON, MARYJO
Entity Type:Individual
Prefix:
First Name:MARYJO
Middle Name:
Last Name:TURGEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARYJO
Other - Middle Name:
Other - Last Name:OLIVEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 JAMAICA ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119-1807
Mailing Address - Country:US
Mailing Address - Phone:413-313-2379
Mailing Address - Fax:
Practice Address - Street 1:206 JAMAICA ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119-1807
Practice Address - Country:US
Practice Address - Phone:413-313-2379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS91385056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health