Provider Demographics
NPI:1134461445
Name:ABBOTT, MARK A (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 REBECCA ANN LN
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-8105
Mailing Address - Country:US
Mailing Address - Phone:508-314-7546
Mailing Address - Fax:
Practice Address - Street 1:23 REBECCA ANN LN
Practice Address - Street 2:
Practice Address - City:EAST FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02536
Practice Address - Country:US
Practice Address - Phone:508-314-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1117631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical