Provider Demographics
NPI:1003360603
Name:MARY C. TARVIN, MSW, LICSW, P.C.
Entity Type:Organization
Organization Name:MARY C. TARVIN, MSW, LICSW, P.C.
Other - Org Name:MARY C. TARVIN, LICSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:TARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-696-4791
Mailing Address - Street 1:5 BYRNE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1703
Mailing Address - Country:US
Mailing Address - Phone:617-696-4791
Mailing Address - Fax:617-507-8354
Practice Address - Street 1:1 WALPOLE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3315
Practice Address - Country:US
Practice Address - Phone:781-414-2247
Practice Address - Fax:781-352-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1146471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty