Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1972 | MA |
Y | 103TC0700X | Clinical Psychologist | 1972 | MA |
N | 102L00000X | Psychologist | 1972 | MA |
N | 103T00000X | Psychologist | 1972 | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | 1972 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1972 | MA |
N | 103TH0100X | Health Service | 1972 | MA |
N | 103TM1800X | Intellectual & Developmental Disabilities | 1972 | MA |
N | 103TP2701X | Group Psychotherapist | 1972 | MA |
N | 103TR0400X | Rehabilitation Psychologist | 1972 | MA |
NPI | 1336204999 |
---|---|
Provider Name | Dr. Nancy Stephanie Mroczek |
First Address | Boston, MA 02116 |
Second Address | Boston, MA 02116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 23/09/2010 |