Provider Demographics
NPI:1821588815
Name:BANDURA, MARY MARGARET (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARGARET
Last Name:BANDURA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 NECK RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-4011
Mailing Address - Country:US
Mailing Address - Phone:401-624-2895
Mailing Address - Fax:
Practice Address - Street 1:10 LANGLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1972
Practice Address - Country:US
Practice Address - Phone:401-624-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3643103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral