| Doctor Name: | MARY A HANNON |
| NPI Number: | 1467402586 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | A PRN |
| License Number: | 254446 |
| Business Practice Address: | 30 Higgins Crowell Rd Psychiatric Collaborative West Yarmouth, MA - 026733444 |
| Business Phone Number: | 5082407964 |
| Business Fax Number: | 5087788581 |
| Mailing Address: | 30 Higgins Crowell Rd, Psychiatric Collaborative WEST YARMOUTH |
| State: | MA |
| Postal Code: | 026733444 |
| Phone Number: | 5082407964 |
| Fax Number: | 5087788581 |
| NPI Enumeration Date: | 05/11/2006 |
| NPI Last Update Date: | 03/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SP0809X |
| License Number: | 254446 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |