Provider Demographics
NPI:1457820169
Name:BEATON, MARYANN (MSW; LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:BEATON
Suffix:
Gender:F
Credentials:MSW; 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 LYNDE ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3446
Mailing Address - Country:US
Mailing Address - Phone:978-314-8572
Mailing Address - Fax:
Practice Address - Street 1:8 BONAIR ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-3104
Practice Address - Country:US
Practice Address - Phone:617-625-6600
Practice Address - Fax:617-628-6837
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025406101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool