=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740765569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARLENE MAJOR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2018
-----------------------------------------------------
Last Update Date | 09/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 76 BEDFORD ST STE 2
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02420-4640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-564-3456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 59 OXBOW RD
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01773-5014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-259-0015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARLENE MAJOR
-----------------------------------------------------
Credential | EDD, MED, RESPECIALI
-----------------------------------------------------
Telephone | 617-564-3456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------