Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 7563 | MA |
N | 103TC0700X | Clinical Psychologist | 7563 | MA |
N | 103G00000X | Clinical Psychologist | 7563 | MA |
N | 103TC0700X | Clinical Psychologist | 7563 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 7563 | MA |
NPI | 1114084035 |
---|---|
Provider Name | Ms. Mary L. Calabrese |
First Address | Cambridge, MA 02139-2250 |
Second Address | Cambridge, MA 02139-2250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |