Healthcare Provider Details

I. General information

NPI: 1023256336
Provider Name (Legal Business Name): MARIA CARMEL GURUCHARRI ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 WARREN AVE MCKINLEY ELEMENTARY
BOSTON MA
02116
US

IV. Provider business mailing address

90 WARREN AVE MCKINLEY ELEMENTARY
BOSTON MA
02116
US

V. Phone/Fax

Practice location:
  • Phone: 617-635-9978
  • Fax: 617-635-9985
Mailing address:
  • Phone: 617-635-9978
  • Fax: 617-635-9985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3747
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: