Provider Demographics
NPI:1417014515
Name:ALBERT, MARY ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:ALBERT
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 1:505 TREMONT ST
Mailing Address - Street 2:UNIT 710
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6353
Mailing Address - Country:US
Mailing Address - Phone:617-867-7779
Mailing Address - Fax:
Practice Address - Street 1:129 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-9106
Practice Address - Country:US
Practice Address - Phone:617-731-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10261841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1004580OtherNEIGHBORHOOD HEALTH PLAN
MA292600OtherHMO BLUE
MA04339431501OtherPACIFICARE
MA7902106OtherAETNA
MA1857894Medicaid
MAP07299OtherBLUE CROSS
MA292600OtherHMO BLUE