Provider Demographics
NPI:1003000910
Name:BASS, MARTHA BROWNSTEIN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:BROWNSTEIN
Last Name:BASS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WAYLAND HILLS RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3810
Mailing Address - Country:US
Mailing Address - Phone:508-653-0451
Mailing Address - Fax:508-653-6094
Practice Address - Street 1:16 WAYLAND HILLS RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-3810
Practice Address - Country:US
Practice Address - Phone:508-653-0451
Practice Address - Fax:508-653-6094
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10224891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical