Provider Demographics
NPI:1841048618
Name:BAGEPALLI, MAANASI
Entity type:Individual
Prefix:
First Name:MAANASI
Middle Name:
Last Name:BAGEPALLI
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 1:177 ROBERT RD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-6531
Mailing Address - Country:US
Mailing Address - Phone:774-463-6941
Mailing Address - Fax:
Practice Address - Street 1:177 ROBERT RD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-6531
Practice Address - Country:US
Practice Address - Phone:774-463-6941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician