Provider Demographics
NPI:1245734573
Name:DAVIEAU, MARIECA CATHRYN (MSW, LICSW, CCM)
Entity Type:Individual
Prefix:
First Name:MARIECA
Middle Name:CATHRYN
Last Name:DAVIEAU
Suffix:
Gender:F
Credentials:MSW, LICSW, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HARTSHORN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2904
Mailing Address - Country:US
Mailing Address - Phone:508-890-6407
Mailing Address - Fax:508-890-6410
Practice Address - Street 1:50 PRESCOTT ST STE 3300
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2652
Practice Address - Country:US
Practice Address - Phone:508-890-6400
Practice Address - Fax:508-890-6410
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10293791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical