Provider Demographics
NPI:1881179695
Name:EUSTACHE, MARCIA (MS)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:
Last Name:EUSTACHE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MERRIMACK ST STE 9
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1764
Mailing Address - Country:US
Mailing Address - Phone:978-688-4830
Mailing Address - Fax:978-688-4901
Practice Address - Street 1:3637 2ND PL SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-3173
Practice Address - Country:US
Practice Address - Phone:561-503-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health