Provider Demographics
NPI:1306047386
Name:BRESNAHAN- NOYES, MARY LORRAINE (MS CCC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LORRAINE
Last Name:BRESNAHAN- NOYES
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 GROVELAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1818
Mailing Address - Country:US
Mailing Address - Phone:781-682-7971
Mailing Address - Fax:
Practice Address - Street 1:77 GROVELAND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-3116
Practice Address - Country:US
Practice Address - Phone:781-682-7971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist