Provider Demographics
NPI:1497238158
Name:PETROVICH, MARGARET M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:M
Last Name:PETROVICH
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 GLEN GARY RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1346
Mailing Address - Country:US
Mailing Address - Phone:781-455-0461
Mailing Address - Fax:
Practice Address - Street 1:28 GLEN GARY RD
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1346
Practice Address - Country:US
Practice Address - Phone:781-455-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10195331041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool