Provider Demographics
NPI:1780749010
Name:MARQUEZ, JANET G (LMFT)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:G
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PONTIAC AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920
Mailing Address - Country:US
Mailing Address - Phone:401-419-0627
Mailing Address - Fax:401-737-0830
Practice Address - Street 1:1500 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920
Practice Address - Country:US
Practice Address - Phone:401-419-0627
Practice Address - Fax:401-737-0830
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMFT00055106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI22408-4OtherBLUE CROSS BLUE SHIELD
RIJM06909Medicaid
RI410988OtherBLUE CHIP