Provider Demographics
NPI:1235612904
Name:SHAPIRO-IDE, MARCI SUSAN (LICSW)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:SUSAN
Last Name:SHAPIRO-IDE
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:ARLINGTON COUNCIL ON AGING
Mailing Address - Street 2:27 MAPLE STREET
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476
Mailing Address - Country:US
Mailing Address - Phone:781-316-3400
Mailing Address - Fax:
Practice Address - Street 1:ARLINGTON COUNCIL ON AGING, 27 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476
Practice Address - Country:US
Practice Address - Phone:781-316-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA114348-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical