Provider Demographics
NPI:1700951274
Name:MARROQUIN, ARTHUR R (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:R
Last Name:MARROQUIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 PACKARD ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3810
Mailing Address - Country:US
Mailing Address - Phone:734-761-1419
Mailing Address - Fax:734-429-4561
Practice Address - Street 1:1207 PACKARD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3810
Practice Address - Country:US
Practice Address - Phone:734-761-1419
Practice Address - Fax:734-429-4561
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002932103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist