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NPI Code Detail

MEDICARE: MS. ANN MARIE MANNINO MA, CEIS

MEDICARE: MS. ANN MARIE MANNINO MA, CEIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist

General Provider Information

NPI Number : 1376723890
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANN MARIE MANNINO MA, CEIS
Provider Business Mailing Address
First Line : 10J GILL ST
Second Line :
City : WOBURN
State : MA
Zip : 01801-1721
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10J GILL ST
Second Line :
City : WOBURN
State : MA
Zip : 01801-1721
Country : US
Telephone Number : 781-932-2888
Fax Number : 781-932-9809
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2007
Last Update Date : 11/13/2007

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Directions to “ MS. ANN MARIE MANNINO MA, CEIS” Practice Location

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