Provider Demographics
NPI:1770892317
Name:MARAYELLE, JUDITH (MSED, LP)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:MARAYELLE
Suffix:
Gender:F
Credentials:MSED, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15841 27TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1900
Mailing Address - Country:US
Mailing Address - Phone:952-334-6446
Mailing Address - Fax:
Practice Address - Street 1:5900 GREEN OAK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-4708
Practice Address - Country:US
Practice Address - Phone:952-334-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5275103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist