Provider Demographics
NPI:1134371222
Name:DUNNE, MARA ELLEN (MSED)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:ELLEN
Last Name:DUNNE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2004
Mailing Address - Country:US
Mailing Address - Phone:845-856-9752
Mailing Address - Fax:
Practice Address - Street 1:43 CONESTOGA TRL
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2509
Practice Address - Country:US
Practice Address - Phone:914-443-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency