Provider Demographics
NPI:1972093227
Name:GALVIN, MARYANNE (ED D)
Entity Type:Individual
Prefix:DR
First Name:MARYANNE
Middle Name:
Last Name:GALVIN
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W BROADWAY UNIT 213
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1045
Mailing Address - Country:US
Mailing Address - Phone:617-266-0884
Mailing Address - Fax:
Practice Address - Street 1:9 W BROADWAY UNIT 213
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1045
Practice Address - Country:US
Practice Address - Phone:617-266-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2737103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist