Provider Demographics
NPI:1053876029
Name:PURCELL, MAURA S (ABT)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:S
Last Name:PURCELL
Suffix:
Gender:F
Credentials:ABT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 WILKINS GLEN RD APT 4
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2036
Mailing Address - Country:US
Mailing Address - Phone:774-210-2665
Mailing Address - Fax:
Practice Address - Street 1:43 CHUBB RD APT 4
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-7804
Practice Address - Country:US
Practice Address - Phone:774-210-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician