Provider Demographics
NPI:1437268117
Name:MOBLEY, ERNEST DAVID (LICSW)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:DAVID
Last Name:MOBLEY
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 1:184 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2808
Mailing Address - Country:US
Mailing Address - Phone:508-359-5168
Mailing Address - Fax:
Practice Address - Street 1:63 FOUNTAIN ST STE 402
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6280
Practice Address - Country:US
Practice Address - Phone:508-872-4813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1027431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P23595Medicare PIN