Healthcare Provider Details

I. General information

NPI: 1548862162
Provider Name (Legal Business Name): MARISA MENDEL MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 WELLS AVE STE 102
NEWTON CENTRE MA
02459-3320
US

IV. Provider business mailing address

199 WELLS AVE STE 102
NEWTON CENTRE MA
02459-3320
US

V. Phone/Fax

Practice location:
  • Phone: 781-472-1477
  • Fax: 412-753-7640
Mailing address:
  • Phone: 781-472-1477
  • Fax: 412-753-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARISA R MENDEL
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 781-472-1477