Provider Demographics
NPI:1215977590
Name:MCMANUS, MARY (LICSW)
Entity type:Individual
Prefix:MR
First Name:MARY
Middle Name:
Last Name:MCMANUS
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 1:30 ELIOT ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1408
Mailing Address - Country:US
Mailing Address - Phone:617-277-6261
Mailing Address - Fax:
Practice Address - Street 1:251 CAUSEWAY STREET
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-248-1159
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1066471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical