Provider Demographics
NPI:1891997615
Name:BROLLY, MARY E (PSYD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BROLLY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5434
Mailing Address - Country:US
Mailing Address - Phone:781-519-9715
Mailing Address - Fax:508-580-4404
Practice Address - Street 1:985 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5434
Practice Address - Country:US
Practice Address - Phone:781-519-9715
Practice Address - Fax:508-580-4404
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9836103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical