Provider Demographics
NPI:1982840674
Name:MORANO, MARK (MT, NU, CNS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:MORANO
Suffix:
Gender:M
Credentials:MT, NU, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3801
Mailing Address - Country:US
Mailing Address - Phone:617-247-2108
Mailing Address - Fax:
Practice Address - Street 1:877 BEACON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3801
Practice Address - Country:US
Practice Address - Phone:617-247-2108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1887133N00000X
MA2148225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist