Provider Demographics
NPI:1326462557
Name:FLETCHER, ANN M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:M
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:G
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 CHURCH ST.
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452
Mailing Address - Country:US
Mailing Address - Phone:781-893-6659
Mailing Address - Fax:
Practice Address - Street 1:100 CHURCH ST.
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452
Practice Address - Country:US
Practice Address - Phone:781-893-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10275361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical