Provider Demographics
NPI:1477747905
Name:VESPRINI, MARY ELLEN (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:VESPRINI
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 1:76 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950
Mailing Address - Country:US
Mailing Address - Phone:703-969-6533
Mailing Address - Fax:
Practice Address - Street 1:51A PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2625
Practice Address - Country:US
Practice Address - Phone:978-992-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2019-05-31
Deactivation Date:2012-04-19
Deactivation Code:
Reactivation Date:2016-11-28
Provider Licenses
StateLicense IDTaxonomies
MA10267791041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD941L70Medicare UPIN
MD58956180Medicaid