Provider Demographics
NPI:1134936610
Name:EKEH, MARYDINNA
Entity type:Individual
Prefix:
First Name:MARYDINNA
Middle Name:
Last Name:EKEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OXFORD AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01571-3279
Mailing Address - Country:US
Mailing Address - Phone:774-502-1881
Mailing Address - Fax:
Practice Address - Street 1:30 OXFORD AVE APT 1A
Practice Address - Street 2:
Practice Address - City:DUDLEY
Practice Address - State:MA
Practice Address - Zip Code:01571-3279
Practice Address - Country:US
Practice Address - Phone:774-502-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician