=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326382730
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAKENNA ARRIGO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2012
-----------------------------------------------------
Last Update Date | 09/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 WINGATE ST
-----------------------------------------------------
City | HAVERHILL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01832-5759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-241-4908
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3840 DEER RIVER RD
-----------------------------------------------------
City | CARTHAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13619-2206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-360-1623
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 123216
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------