Provider Demographics
NPI:1356834584
Name:ARCHIBALD, ANA LUIZA (LICSW)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LUIZA
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:LUIZA
Other - Last Name:BRENNER MASCAGNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:37 GOLDSMITH ST # 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3121
Mailing Address - Country:US
Mailing Address - Phone:617-413-5898
Mailing Address - Fax:
Practice Address - Street 1:160 STATE ST FL 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-2540
Practice Address - Country:US
Practice Address - Phone:617-410-4902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1177961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical