Provider Demographics
NPI:1417016965
Name:CHERUBIM, MARK (LICSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CHERUBIM
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155A LOVERING STREET
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053
Mailing Address - Country:US
Mailing Address - Phone:508-523-8736
Mailing Address - Fax:508-533-4103
Practice Address - Street 1:155A LOVERING ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-2331
Practice Address - Country:US
Practice Address - Phone:508-523-8736
Practice Address - Fax:508-533-4103
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1120811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical