Healthcare Provider Details

I. General information

NPI: 1396854394
Provider Name (Legal Business Name): GEORGIANNA K. MARKS PHD, APRN, PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CUSHING AVE ST MARY'S CHURCH
BOSTON MA
02125
US

IV. Provider business mailing address

14 CUSHING AVE ST MARY'S CENTER
BOSTON MA
02125
US

V. Phone/Fax

Practice location:
  • Phone: 857-230-0983
  • Fax: 866-610-6501
Mailing address:
  • Phone: 857-230-0983
  • Fax: 866-610-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number124796
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: