Provider Demographics
NPI:1356379044
Name:ANDERSON, MARCIA K (PHD, LATC)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD, LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 KING PHILIP RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-3021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ADRIAN TINSLEY CENTER
Practice Address - Street 2:BRIDGEWATER STATE COLLEGE
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02325-0001
Practice Address - Country:US
Practice Address - Phone:508-531-2072
Practice Address - Fax:508-531-1717
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAT-217171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor