| Doctor Name: | DR. MARY KNORRING PANTUHOVA |
| NPI Number: | 1497701197 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | 6733 |
| Business Practice Address: | 91 Wyman St Waban, MA - 024681529 |
| Business Phone Number: | 6173327596 |
| Business Fax Number: | 6176636135 |
| Mailing Address: | 91 Wyman St, WABAN |
| State: | MA |
| Postal Code: | 024681529 |
| Phone Number: | 6173327596 |
| Fax Number: | 6176636135 |
| NPI Enumeration Date: | 05/25/2006 |
| NPI Last Update Date: | 12/08/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 6733 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |