Provider Demographics
NPI:1285636902
Name:HATHAWAY, MAUREEN ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:HATHAWAY
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 1:355 UNION ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3694
Mailing Address - Country:US
Mailing Address - Phone:508-996-6225
Mailing Address - Fax:
Practice Address - Street 1:355 UNION ST
Practice Address - Street 2:UNIT 1
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3694
Practice Address - Country:US
Practice Address - Phone:508-996-6225
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10206941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1858696Medicaid
MAHAP22892Medicare ID - Type Unspecified