Doctor Name: | MARY K LOGAN |
NPI Number: | 1013152982 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA |
License Number: | |
Business Practice Address: | 15 Union St 2nd Floor Lawrence, MA - 018401866 |
Business Phone Number: | 9786884830 |
Business Fax Number: | |
Mailing Address: | 15 Union St, 2nd Floor LAWRENCE |
State: | MA |
Postal Code: | 018401866 |
Phone Number: | 9786884830 |
Fax Number: | |
NPI Enumeration Date: | 12/08/2008 |
NPI Last Update Date: | 12/08/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |