Individual
DR. MARY KNORRING PANTUHOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
91 WYMAN ST, WABAN, MA 02468-1529
(617) 332-7596
(617) 663-6135
Mailing address
91 WYMAN ST, WABAN, MA 02468-1529
(617) 332-7596
(617) 663-6135
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6733
MA
103TC2200X
Clinical Child & Adolescent Psychologist
6733
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497701197
NPI
MA
01
—
W40013
MEDICARE
MA
Enumeration date
05/25/2006
Last updated
12/08/2009
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