MEDICARE: MARI C BENNASAR PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6893	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922012616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARI C BENNASAR PSYD

Provider Business Mailing Address
First Line	:	85 E NEWTON ST
Second Line	:	M912
City	:	BOSTON
State	:	MA
Zip	:	02118-2340
Country	:	US
Telephone Number	:	508-303-6722
Fax Number	:	617-414-4792

Provider Business Practice Location Address
First Line	:	85 E NEWTON ST
Second Line	:	M912
City	:	BOSTON
State	:	MA
Zip	:	02118-2340
Country	:	US
Telephone Number	:	508-303-6722
Fax Number	:	617-414-4792

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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Directions to “ MARI C BENNASAR PSYD” Practice Location

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