Provider Demographics
NPI:1942827738
Name:MARTIN-MCNULTY, LORRAINE CECILE
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:CECILE
Last Name:MARTIN-MCNULTY
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 1:132 MASS MOCA WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-2446
Mailing Address - Country:US
Mailing Address - Phone:413-644-4600
Mailing Address - Fax:413-664-4660
Practice Address - Street 1:87 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2402
Practice Address - Country:US
Practice Address - Phone:413-644-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN167652363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health