Individual
MARY GONCALO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, MS, CS
Contact information
Practice address
101 SULLIVAN DR, FALL RIVER, MA 02721-6812
(774) 644-5629
(508) 678-8100
Mailing address
P O BOX 365, SOMERSET, MA 02726-0365
(774) 644-5629
(508) 678-8100
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
197997
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000024517
BOSTON MEDICAL HEALTHNET
—
01
—
103300
NHP
—
05
—
11089087A
—
MA
05
—
1894480
—
MA
01
—
214375
BC BS OF RI
RI
01
—
410198-001
BLUE CHIP
RI
01
—
585968000
MAGELLAN
—
01
—
60054
AETNA
—
01
—
PN0790
BLUE CROSS BLUE CHIELD
MA
Enumeration date
10/03/2006
Last updated
05/15/2023
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