Healthcare Provider Details

I. General information

NPI: 1417340498
Provider Name (Legal Business Name): MARIANA GUIMARAES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2015
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 TURNPIKE RD
SOUTHBOROUGH MA
01772-2108
US

IV. Provider business mailing address

33 TURNPIKE RD
SOUTHBOROUGH MA
01772-2108
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-1015
  • Fax:
Mailing address:
  • Phone: 508-481-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: