MARY R INNIS (NPI# 1053366963) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053366963 |
| Entity Type | Individual |
| Full Name | MARY R INNIS |
| Credential | RN PC |
| Practice Address |
100 Century Dr Worcester MA 01606 |
| Mailing Address |
Po Box 415348 Provider Enrollment Boston MA 02241-5348 |
| Practice Telephone | 5087625400 |
| Practice Fax Number | 5087625410 |
| Mailing Telephone | 8002258885 |
| Mailing Fax Number | 5083341977 |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2018-11-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SP0809X |
Clinical Nurse Specialist Specialization: Psych/Mental Health, Adult |
167110 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 279 Lincoln St, Umass Memorial Med Ctr, Ambulatory Psychiatry Service, Worcester, MA 016052120 | 5083342537 | 5083343000 |
| Street Address |
100 CENTURY DR |
| City | WORCESTER |
| State | MA |
| Zip Code | 01606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831180686 | Alan P. Brown | Psychiatry & Neurology | 100 Century Dr, Worcester, MA 01606-1244 | 2005-11-01 |
| 1710596499 | Christopher Catalfamo | Psychologist | 100 Century Dr, Worcester, MA 01606-1244 | 2020-07-28 |
| 1609404607 | Lily Gracewood Millen | Student in an Organized Health Care Education/Training Program | 100 Century Dr, Worcester, MA 01606-1244 | 2020-03-27 |
| 1184251332 | Alexandra Elizabeth Pumilia | Student in an Organized Health Care Education/Training Program | 100 Century Dr, Worcester, MA 01606-1244 | 2020-03-26 |
| 1003446782 | Kara Naylon | Psychologist | 100 Century Dr, Worcester, MA 01606-1244 | 2020-01-22 |
| 1154884963 | Ines Basten | Student in an Organized Health Care Education/Training Program | 100 Century Dr, Worcester, MA 01606-1244 | 2019-04-09 |
| 1124509534 | Vera Alejandra Klinoff | Clinical Neuropsychologist | 100 Century Dr, Worcester, MA 01606-1244 | 2018-08-23 |
| 1346728748 | T Massachusetts, LLC | Psychiatric Hospital | 100 Century Dr, Worcester, MA 01606-1244 | 2018-07-30 |
| 1316432917 | Alessia Ritacco | Nurse Practitioner | 100 Century Dr, Worcester, MA 01606 | 2018-06-26 |
| 1629578885 | Christopher Parmanand | Nurse Practitioner | 100 Century Dr, Worcester, MA 01606-1244 | 2018-02-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548742612 | Aishea Irine Henry | Counselor | 29 E. Mountian St., Worccester, MA 01606 | 2018-09-05 |
| 1932689874 | Donna Kesler Pearce | Social Worker | Department of Children and Families, 151 West Boylston Drive, Worcester, MA 01606 | 2018-08-20 |
| 1689169914 | Ashley Kalel | Social Worker | 151 W Boylston Dr, Worcester, MA 01606 | 2018-06-28 |
| 1588189039 | Michael Joseph Peters Sr. | Counselor | 56 Malden St, Worcester, MA 01606 | 2017-08-06 |
| 1811418528 | Shan Rai | Social Worker | 29 East Mountain Street, Worcester, MA 01606 | 2017-07-03 |
| 1639608045 | Kim Marie Ceccarini | Case Manager/Care Coordinator | 11 Delaval Rd, Worcester, MA 01606 | 2017-06-08 |
| 1669806139 | Lauren Giuliano | Counselor | 392 Burncoat St, Worcester, MA 01606 | 2013-09-02 |
| 1508132911 | Joshua D Zierler-broudo | Social Worker | 29 East Mountain St, Worcester, MA 01606 | 2012-03-29 |
| 1609096098 | Alternatives Unlimited Inc | Day Training, Developmentally Disabled Services | 367 Burncoat Street, Worcester, MA 01606 | 2007-04-26 |
| 1407908213 | Class One Orthodontic Asso LLC | Dentist | 365 Burncoat St, Worcester, MA 01606 | 2007-01-18 |
| Find all providers in zip 01606 | ||||
| Taxonomy Code | 364SP0809X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Psych/Mental Health, Adult |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447330287 | Jane S Ferguson | Clinical Nurse Specialist | 162 Chandler St, Worcester, MA 01609-2924 | 2006-10-16 |
| 1871530600 | Rebecca Kardon | Clinical Nurse Specialist | 26 Queen Street, Ground Floor, Umass Memorial Med Ctr, Ambulatory Psychiatry Service, Worcester, MA 01610 | 2006-06-01 |
| 1033448188 | Ursula Sawicki Makrum | Clinical Nurse Specialist | 72 Jaques Ave, Worcester, MA 01610-2476 | 2009-12-21 |
| 1992942148 | Sun S Kim | Clinical Nurse Specialist | 328 Shrewsbury St, Department of Psychiatry, Worcester, MA 01604-4613 | 2009-01-09 |
| 1083764237 | Kathryn Yvonne Raymond | Clinical Nurse Specialist | 305 Belmont St, Worcester, MA 01604-1681 | 2007-01-11 |
| 1619067568 | Sally Ann Blomgren | Clinical Nurse Specialist | 78 Burncoat St, Worcester, MA 01605-1350 | 2006-10-13 |
| 1174624753 | Margaret Burley | Clinical Nurse Specialist | 5 Neponset St, Worcester, MA 01606-2714 | 2006-09-26 |
| 1720189525 | Sharon Divitto | Clinical Nurse Specialist | 55 Lake Ave N, Ummmc, Department of Psychiatry, Worcester, MA 01655-0002 | 2006-09-26 |
| 1811098601 | Karen C Kappes | Clinical Nurse Specialist | 55 Lake Ave N, Ummmc, Department of Psychiatry, Worcester, MA 01655-0002 | 2006-09-26 |
| 1710926068 | Karen Nordstrom | Clinical Nurse Specialist | 26 Queen Street, Ground Floor, Umass Memorial Med Ctr, Ambulatory Psychiatry Service, Worcester, MA 01610 | 2006-06-05 |
| Find all providers in WORCESTER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.