Provider Demographics
NPI:1598488678
Name:O'HANLEY, MARY ELENA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELENA
Last Name:O'HANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ROCKY POND RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3603
Mailing Address - Country:US
Mailing Address - Phone:781-936-5220
Mailing Address - Fax:
Practice Address - Street 1:15 ROCKY POND RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3603
Practice Address - Country:US
Practice Address - Phone:781-936-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
XXD964325330OtherBLUE CROSS BLUE SHIELD