Provider Demographics
NPI:1073847026
Name:WEST, MARCY WYNNE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARCY
Middle Name:WYNNE
Last Name:WEST
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 1:431 RIVER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5483
Mailing Address - Country:US
Mailing Address - Phone:781-966-5697
Mailing Address - Fax:781-338-2217
Practice Address - Street 1:431 RIVER ST STE 1
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5483
Practice Address - Country:US
Practice Address - Phone:781-966-5697
Practice Address - Fax:781-338-2217
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MA1167111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker