Provider Demographics
NPI:1508074493
Name:KANE, MARYANN (EDD)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 WATER ST
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2424
Mailing Address - Country:US
Mailing Address - Phone:603-580-5920
Mailing Address - Fax:603-778-0022
Practice Address - Street 1:163 WATER ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2424
Practice Address - Country:US
Practice Address - Phone:603-580-5920
Practice Address - Fax:603-778-0022
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH709103TC0700X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30424962Medicaid
NH30424962Medicaid