Provider Demographics
NPI:1437543493
Name:DINALLO, MARY CATHERINE (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:DINALLO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:450 PEARL ST STE 3&3B
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1610
Mailing Address - Country:US
Mailing Address - Phone:781-344-0057
Mailing Address - Fax:781-344-0027
Practice Address - Street 1:450 PEARL ST STE 3&3B
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1610
Practice Address - Country:US
Practice Address - Phone:781-344-0057
Practice Address - Fax:603-628-7757
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0120889363LP0808X
NYF401914-1363LP0808X
NH073114-23363LP0808X
MARN209398363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health