Provider Demographics
NPI:1104993831
Name:CABAN, MARY A (LIC AC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:CABAN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SARAH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-1214
Mailing Address - Country:US
Mailing Address - Phone:781-643-5555
Mailing Address - Fax:
Practice Address - Street 1:6 SARAH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-1214
Practice Address - Country:US
Practice Address - Phone:781-643-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19009183500000X
MA216159171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No183500000XPharmacy Service ProvidersPharmacist