Provider Demographics
NPI:1811338098
Name:BORGELLAS, MACMICHEL
Entity type:Individual
Prefix:
First Name:MACMICHEL
Middle Name:
Last Name:BORGELLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 FAUNCE CORNER RD STE K
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1263
Mailing Address - Country:US
Mailing Address - Phone:774-206-1125
Mailing Address - Fax:774-628-9657
Practice Address - Street 1:145 FAUNCE CORNER RD STE K
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1263
Practice Address - Country:US
Practice Address - Phone:774-206-1125
Practice Address - Fax:774-628-9657
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst