Provider Demographics
NPI:1881349710
Name:DE CAMPOS, MARCIA MARIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:MARIA
Last Name:DE CAMPOS
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 1:208 SWANSON RD UNIT 536
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-1333
Mailing Address - Country:US
Mailing Address - Phone:978-893-8532
Mailing Address - Fax:
Practice Address - Street 1:240 BEDFORD ST STE 5
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3400
Practice Address - Country:US
Practice Address - Phone:978-893-8532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist