Basic Information
| Provider Information | |||||||||
| NPI: | 1639136427 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROMANOFF RAND | ||||||||
| FirstName: | MARIA | ||||||||
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| Credential: | NP | ||||||||
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| OtherLastName: | ROMANOFF | ||||||||
| OtherFirstName: | MARIA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 500 VICTORY RD | ||||||||
| Address2: | SOUTH SHORE MENTAL HEALTH | ||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021713139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088620514 | ||||||||
| FaxNumber: | 5088629184 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 BARNSTABLE RD | ||||||||
| Address2: | BAYVIEWASSOCIATES | ||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026012902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088620514 | ||||||||
| FaxNumber: | 5088629417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 04/24/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 250787 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 364SP0808X | 250787 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
No ID Information.