Healthcare Provider Details

I. General information

NPI: 1285871087
Provider Name (Legal Business Name): MARY ANN A MCDONNELL RNCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 OLD DERBY ST STE 457
HINGHAM MA
02043-4062
US

IV. Provider business mailing address

859 WILLARD ST STE 430
QUINCY MA
02169-7482
US

V. Phone/Fax

Practice location:
  • Phone: 781-837-8833
  • Fax: 781-735-0457
Mailing address:
  • Phone: 617-847-1950
  • Fax: 617-774-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number198161
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number198161
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: