Healthcare Provider Details

I. General information

NPI: 1972064426
Provider Name (Legal Business Name): MADELEINE MERCUN MCGUIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MASSACHUSETTS AVE
ARLINGTON MA
02474-8435
US

IV. Provider business mailing address

226 MASSACHUSETTS AVE
ARLINGTON MA
02474-8435
US

V. Phone/Fax

Practice location:
  • Phone: 617-977-4470
  • Fax:
Mailing address:
  • Phone: 617-977-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10001424
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: