Provider Demographics
NPI:1396227054
Name:WARD, MARY M (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:WARD
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 BLUE HILL AVE FL DCF 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-4323
Mailing Address - Country:US
Mailing Address - Phone:617-989-9209
Mailing Address - Fax:
Practice Address - Street 1:451 BLUE HILL AVE FL DCF 2
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-4323
Practice Address - Country:US
Practice Address - Phone:617-989-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1181691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical