Provider Demographics
NPI:1235306697
Name:DRUMMOND, MILDRED KEITH (MSW)
Entity Type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:KEITH
Last Name:DRUMMOND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:KEITH
Other - Last Name:DRUMMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:301 CORDAVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1024
Mailing Address - Country:US
Mailing Address - Phone:508-881-0819
Mailing Address - Fax:
Practice Address - Street 1:79 MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-2945
Practice Address - Country:US
Practice Address - Phone:508-626-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1139541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA113954OtherLICSW