Provider Demographics
NPI:1255401832
Name:PEUQUET, MARILYN (MA)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:PEUQUET
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1452
Mailing Address - Country:US
Mailing Address - Phone:610-444-5693
Mailing Address - Fax:
Practice Address - Street 1:819 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1452
Practice Address - Country:US
Practice Address - Phone:610-444-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005089L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist