Mary Pantuhova, Psy.D., LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6733 Issued in MA

Legal business name

MARY PANTUHOVA, PSY.D., LLC

Practice address

91 Wyman St
Waban, MA 02468-1529

Phone

(617) 332-7596

NPI assigned

May 6, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mary Knorring Pantuhova, PSY.D.NPI 1497701197

Title

Director

Phone

(617) 332-7596

Specialties & licenses 1

Addresses

Other names 1

• Mary Pantuhova, Psy.D. Former legal business name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Knorring Pantuhova, PSY.D.

  • Clinical Psychologist
  • Waban, MA
  • NPI 1497701197
  NPD (past) Authorized official
• Seth A Rafal, M.D.

  • Psychiatry Physician
  • Waban, MA
  • NPI 1346365293
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210032000000",
    "number": "1023284460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 WYMAN ST",
            "city": "WABAN",
            "state": "MA",
            "postal_code": "024681529",
            "telephone_number": "617-332-7596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 WYMAN ST",
            "city": "WABAN",
            "state": "MA",
            "postal_code": "024681529",
            "telephone_number": "617-332-7596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY PANTUHOVA, PSY.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-06",
        "last_updated": "2008-05-06",
        "status": "A",
        "authorized_official_last_name": "PANTUHOVA",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KNORRING",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "617-332-7596",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "6733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Pantuhova, Psy.D.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Rheta Grenoble Keylor, PH.D.
• Nicole Lemaster, BCBA
• Lois A Levin, PHD
• Ruth Levine Arnold, M.S.
• Catherine Josephine Luchini Gerson, PT
• Erica Melmed, M.S, CCC-SLP
• Patricia Miller-Katz, LICSW
• Caroline Miller, PSY.D.
• Iris Lynn Miller, PSY.D.
• Lawrence G Miller, M.D.

• Clinical Psychologist in Waban, MA
• Providers in Waban, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.