Provider Demographics
NPI:1407949761
Name:DUMAS, MARTHA MARIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:MARIE
Last Name:DUMAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 POMPANO RD
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2059
Mailing Address - Country:US
Mailing Address - Phone:508-362-0383
Mailing Address - Fax:
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4525
Practice Address - Country:US
Practice Address - Phone:508-655-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10277961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1853597Medicaid
MADU P23167Medicare ID - Type Unspecified