Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1255868212 |
---|---|
Provider Name | Emily Mcmanus |
First Address | South Walpole, MA 02071-1006 |
Second Address | Berkley, MA 02779-1720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2017 |
Last Update Date | 21/05/2017 |