Provider Demographics
NPI:1003928656
Name:NEWMAN, MARILYN (LICSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:NEWMAN
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 1:365 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3023
Mailing Address - Country:US
Mailing Address - Phone:978-443-5909
Mailing Address - Fax:
Practice Address - Street 1:365 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3023
Practice Address - Country:US
Practice Address - Phone:978-443-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105230104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
P03542OtherBC/BS
MA105230OtherTUFTS
MA105230OtherTUFTS