Provider Demographics
NPI:1700337391
Name:MARQUEZ, AWILDA
Entity Type:Individual
Prefix:
First Name:AWILDA
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 MACOMBS RD
Mailing Address - Street 2:5J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7615
Mailing Address - Country:US
Mailing Address - Phone:347-885-2240
Mailing Address - Fax:
Practice Address - Street 1:1674 MACOMBS RD
Practice Address - Street 2:5J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7615
Practice Address - Country:US
Practice Address - Phone:347-885-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool