Provider Demographics
NPI:1689111973
Name:COLE, MARYELLEN ELIZABETH (BS)
Entity Type:Individual
Prefix:MS
First Name:MARYELLEN
Middle Name:ELIZABETH
Last Name:COLE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 BLACKSTONE STREET
Mailing Address - Street 2:
Mailing Address - City:UXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01569
Mailing Address - Country:US
Mailing Address - Phone:508-234-4181
Mailing Address - Fax:
Practice Address - Street 1:270 BLACKSTONE STREET
Practice Address - Street 2:
Practice Address - City:UXBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01569
Practice Address - Country:US
Practice Address - Phone:508-234-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor