Provider Demographics
NPI:1497067557
Name:HOULIHAN, MARY GRANT (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:GRANT
Last Name:HOULIHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 FARM DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3523
Mailing Address - Country:US
Mailing Address - Phone:401-338-6095
Mailing Address - Fax:
Practice Address - Street 1:122 FARM DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-3523
Practice Address - Country:US
Practice Address - Phone:401-338-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN32300163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent