Provider Demographics
NPI:1265497754
Name:CURTIN, PHILIP LEROY (LICSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:LEROY
Last Name:CURTIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 HOLDEN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606
Mailing Address - Country:US
Mailing Address - Phone:508-853-1507
Mailing Address - Fax:
Practice Address - Street 1:154 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBORO
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-870-0647
Practice Address - Fax:508-799-6325
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103743101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22124Medicare ID - Type Unspecified