Provider Demographics
NPI:1043973100
Name:DOCTOR, MARY CATHERINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:DOCTOR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:DOCTOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:71 MARTIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1627
Mailing Address - Country:US
Mailing Address - Phone:615-594-3399
Mailing Address - Fax:
Practice Address - Street 1:555 AMORY ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2652
Practice Address - Country:US
Practice Address - Phone:617-383-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist