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General NPI Number Information
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NPI Number | 1235176538
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Entity Type | Individual
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Provider Name | MARY ELLEN GORMAN RN CS MS
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Gender | Female
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 42 WASHINGTON ST SUITE 210
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City | WELLESLEY
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State | MA
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Zip | 02481
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Country | US
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Telephone | 781-431-1990
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Fax | 781-416-4321
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Provider Business Mailing Address
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Address Line | 42 WASHINGTON ST SUITE 210
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City | WELLESLEY
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State | MA
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Zip | 02481
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Country | US
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Telephone | 781-431-1990
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Fax | 781-416-4321
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 161364
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License Number State | MA
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