Provider Demographics
NPI:1679064935
Name:BORGOS, MARLANA JOYCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARLANA
Middle Name:JOYCE
Last Name:BORGOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HOWLAND FARM RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-2651
Mailing Address - Country:US
Mailing Address - Phone:401-742-2110
Mailing Address - Fax:
Practice Address - Street 1:10 HOWLAND FARM RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-2651
Practice Address - Country:US
Practice Address - Phone:401-742-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9158-PY-PROtherNONE