Provider Demographics
NPI:1417147794
Name:MITLIN, MARJORIE D (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:D
Last Name:MITLIN
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 1:28 S. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2959
Mailing Address - Country:US
Mailing Address - Phone:781-784-6321
Mailing Address - Fax:
Practice Address - Street 1:31 FALCON RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2959
Practice Address - Country:US
Practice Address - Phone:781-784-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1048661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical