MEDICARE: MARY MAYNARD

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
1	235Z00000X	Speech-Language Pathologist	3562	MA

General Provider Information

NPI Number	:	1962921478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MAYNARD

Provider Business Mailing Address
First Line	:	169 LINCOLN ST STE 202
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4640
Country	:	US
Telephone Number	:	671-840-5445
Fax Number	:	781-875-3060

Provider Business Practice Location Address
First Line	:	169 LINCOLN ST STE 202
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4640
Country	:	US
Telephone Number	:	617-840-5445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2017
Last Update Date	:	09/15/2017

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Directions to “ MARY MAYNARD ” Practice Location

Language	Start Address	Practice Location

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