Healthcare Provider Details

I. General information

NPI: 1447174669
Provider Name (Legal Business Name): MARY GENEVIEVE WINANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 LELAND HILL RD
SUTTON MA
01590-3853
US

IV. Provider business mailing address

52 LELAND HILL RD
SUTTON MA
01590-3853
US

V. Phone/Fax

Practice location:
  • Phone: 774-280-4079
  • Fax:
Mailing address:
  • Phone: 774-280-4079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: