Provider Demographics
NPI:1114044773
Name:PUTNAM-TODD, MARCIA M (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:M
Last Name:PUTNAM-TODD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3147
Mailing Address - Country:US
Mailing Address - Phone:781-608-5185
Mailing Address - Fax:508-828-9147
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:MILLRIVER PLACE SUITE 1
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3960
Practice Address - Country:US
Practice Address - Phone:508-828-9116
Practice Address - Fax:508-828-9146
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health