Provider Demographics
NPI:1114404720
Name:PUTNAM, DEIRDRE HURLEY (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:HURLEY
Last Name:PUTNAM
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 1:17 BUSH HILL RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-1620
Mailing Address - Country:US
Mailing Address - Phone:978-302-4078
Mailing Address - Fax:978-236-1702
Practice Address - Street 1:500 CUMMINGS CTR STE 6500
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6234
Practice Address - Country:US
Practice Address - Phone:978-236-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1140031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical