Provider Demographics
NPI:1447303425
Name:BORSARI, MARY ELIZABETH (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:BORSARI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 SEEKELL ST
Mailing Address - Street 2:
Mailing Address - City:EAST TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02718-1417
Mailing Address - Country:US
Mailing Address - Phone:508-822-4526
Mailing Address - Fax:
Practice Address - Street 1:369 SEEKELL ST
Practice Address - Street 2:
Practice Address - City:EAST TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02718-1417
Practice Address - Country:US
Practice Address - Phone:508-822-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1826235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0374261Medicaid
MAAA40864OtherHARVARD PILGRIM HEALTH CA
MA1826OtherLICENSE
MASP0168OtherBLUE CROSS BLUE SHIELD
01032198OtherASHA