Provider Demographics
NPI:1831282870
Name:MARQUIS, PATRICIA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 DAVIS ROAD
Mailing Address - Street 2:C-1
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4728
Mailing Address - Country:US
Mailing Address - Phone:978-263-0917
Mailing Address - Fax:
Practice Address - Street 1:336 BAKER AVENUE
Practice Address - Street 2:#1-9
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-369-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA760955OtherTUFTS PROVIDER NUMBER
MA550010005855OtherPACIFIC BEHAVIORAL HEALTH
MAP23456Medicare ID - Type Unspecified