Individual
MARA NUSSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
74 BRIDGE ST, NEWTON, MA 02458
(617) 969-4410
Mailing address
74 BRIDGE ST, NEWTON, MA 02458-1147
(617) 969-4410
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
76865
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/02/2017
Last updated
07/10/2018
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