Healthcare Provider Details

I. General information

NPI: 1417280223
Provider Name (Legal Business Name): MARIS PRICHETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BEACON ST
BROOKLINE MA
02446-4816
US

IV. Provider business mailing address

1415 BEACON ST
BROOKLINE MA
02446-4816
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-2200
  • Fax: 617-278-0200
Mailing address:
  • Phone: 617-566-2200
  • Fax: 617-278-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: