Provider Demographics
NPI:1972909299
Name:MARICLE COUNSELING
Entity Type:Organization
Organization Name:MARICLE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:MARICLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, ATR-BC
Authorized Official - Phone:508-964-2029
Mailing Address - Street 1:34 SCHOOL ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2339
Mailing Address - Country:US
Mailing Address - Phone:508-964-2029
Mailing Address - Fax:
Practice Address - Street 1:34 SCHOOL ST
Practice Address - Street 2:SUITE 209
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2339
Practice Address - Country:US
Practice Address - Phone:508-964-2029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty