| Organization Name: | MARY PANTUHOVA, PSY.D., LLC |
| NPI Number: | 1023284460 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY KNORRING PANTUHOVA (DIRECTOR) |
| Mailing Address: | 91 Wyman St Waban |
| State: | MA US |
| Postal Code: | 024681529 |
| Phone Number: | 6173327596 |
| Fax Number: | |
| NPI Enumeration Date: | 05/06/2008 |
| NPI Last Update Date: | 05/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6733 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |