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General NPI Number Information
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NPI Number | 1144979014
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Entity Type | Individual
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Provider Name | SERENA MAINIERO
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Gender | Female
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Dates
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Enumeration Date | 03/19/2022
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Last Update Date | 03/19/2022
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Provider Practice Location Address
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Address Line | 52 OAK ST
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City | MIDDLEBORO
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State | MA
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Zip | 02346-2078
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Country | US
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Telephone | 508-923-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 259 SHAWMUT AVE APT 2
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City | BOSTON
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State | MA
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Zip | 02118-2168
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Country | US
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Telephone | 401-742-8540
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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