Provider Demographics
NPI:1124588934
Name:MCCANN, BERNARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:MCCANN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WARREN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-5245
Mailing Address - Country:US
Mailing Address - Phone:781-264-6211
Mailing Address - Fax:
Practice Address - Street 1:366 MASSACHUSETTS AVE STE 304
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6732
Practice Address - Country:US
Practice Address - Phone:781-264-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174H00000XOther Service ProvidersHealth Educator