Healthcare Provider Details

I. General information

NPI: 1033722285
Provider Name (Legal Business Name): EMILY MARIE MARQUEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 5TH ST
DOVER NH
03820-2930
US

IV. Provider business mailing address

1 MAIN ST
NASHUA NH
03064-2716
US

V. Phone/Fax

Practice location:
  • Phone: 36-897-8906
  • Fax:
Mailing address:
  • Phone: 603-883-0005
  • Fax: 603-883-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1697
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS2412
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: