Healthcare Provider Details

I. General information

NPI: 1902958507
Provider Name (Legal Business Name): MAREK TRESNAK MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 E MERRIMACK ST UNIT 1
LOWELL MA
01852
US

IV. Provider business mailing address

18 JEAN RD
ARLINGTON MA
02474
US

V. Phone/Fax

Practice location:
  • Phone: 978-453-6800
  • Fax: 978-453-6767
Mailing address:
  • Phone: 508-881-4907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: