Provider Demographics
NPI:1790250744
Name:TOWNSEND MARQUIS, CHARLENE DOROTHY
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:DOROTHY
Last Name:TOWNSEND MARQUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 BRIDGTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3722
Mailing Address - Country:US
Mailing Address - Phone:207-245-1800
Mailing Address - Fax:
Practice Address - Street 1:406 BRIDGTON RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3722
Practice Address - Country:US
Practice Address - Phone:207-897-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator