Provider Demographics
NPI:1437256476
Name:BROGAN, MARY ANN (APN)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:BROGAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:BROGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHCNS,BC
Mailing Address - Street 1:73 HEMENWAY ST
Mailing Address - Street 2:#101
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-2941
Mailing Address - Country:US
Mailing Address - Phone:617-670-1300
Mailing Address - Fax:
Practice Address - Street 1:251 CAUSEWAY ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2148
Practice Address - Country:US
Practice Address - Phone:617-248-1105
Practice Address - Fax:617-248-1121
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA183199163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult