Provider Demographics
NPI:1437295177
Name:TWELVES, MARK (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:TWELVES
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 1:50 SILVER HILL LN APT 12
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3742
Mailing Address - Country:US
Mailing Address - Phone:508-545-0017
Mailing Address - Fax:
Practice Address - Street 1:1853 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-5498
Practice Address - Country:US
Practice Address - Phone:508-545-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10179941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05948Medicare ID - Type Unspecified