Provider Demographics
NPI:1740373695
Name:MCMANN, MAURA T (LICSW)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:T
Last Name:MCMANN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COLONIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066
Mailing Address - Country:US
Mailing Address - Phone:781-545-2540
Mailing Address - Fax:
Practice Address - Street 1:42 TREMONT ST STE 10B
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-5313
Practice Address - Country:US
Practice Address - Phone:781-248-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1066931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04159Medicare ID - Type Unspecified