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General NPI Number Information
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NPI Number | 1316032774
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Entity Type | Individual
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Provider Name | MARY GONCALO RN, MS, CS
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 101 SULLIVAN DR
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City | FALL RIVER
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State | MA
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Zip | 02721-6812
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Country | US
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Telephone | 774-644-5629
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Fax | 508-678-8100
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Provider Business Mailing Address
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Address Line | P O BOX 365
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City | SOMERSET
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State | MA
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Zip | 02726-0365
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Country | US
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Telephone | 774-644-5629
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Fax | 508-678-8100
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 197997
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License Number State | MA
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