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Individual
MARY WOOTEN
Active
Individual
MARY WOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100214979047
MASSHEALTH
MA
01
—
B01010787 00
BOSTON MEDICAL CENTER HEALTHNET PLAN
MA
Enumeration date
03/31/2016
Last updated
03/31/2016
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