Provider Demographics
NPI:1386746865
Name:CHANNELL, MARIA ANNA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ANNA
Last Name:CHANNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 GREELEY ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-1029
Mailing Address - Country:US
Mailing Address - Phone:978-368-0181
Mailing Address - Fax:
Practice Address - Street 1:221 GREELEY ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-1029
Practice Address - Country:US
Practice Address - Phone:978-368-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16807103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical