Healthcare Provider Details

I. General information

NPI: 1942827738
Provider Name (Legal Business Name): LORRAINE CECILE MARTIN-MCNULTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 MARSHALL ST
NORTH ADAMS MA
01247-2402
US

IV. Provider business mailing address

132 MASS MOCA WAY
NORTH ADAMS MA
01247-2446
US

V. Phone/Fax

Practice location:
  • Phone: 413-644-4600
  • Fax:
Mailing address:
  • Phone: 413-644-4600
  • Fax: 413-664-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN167652
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: