Provider Demographics
NPI:1275551798
Name:MCNAMARA, JOHN J (MA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2210 MONROE AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2436
Mailing Address - Country:US
Mailing Address - Phone:585-339-4793
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:2210 MONROE AVE
Practice Address - Street 2:STE 2
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2436
Practice Address - Country:US
Practice Address - Phone:585-338-1400
Practice Address - Fax:585-336-4845
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY000888231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355266Medicaid