Healthcare Provider Details

I. General information

NPI: 1073094207
Provider Name (Legal Business Name): MARY ANN CUCINATTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2018
Last Update Date: 08/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 HYDE PARK AVE
ROSLINDALE MA
02131-3822
US

IV. Provider business mailing address

93 WESSON AVE
QUINCY MA
02169-7411
US

V. Phone/Fax

Practice location:
  • Phone: 617-635-8123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1026302
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: