Provider Demographics
NPI:1497776074
Name:MERTENS, EVE LESEM (MA SSA)
Entity Type:Individual
Prefix:MS
First Name:EVE
Middle Name:LESEM
Last Name:MERTENS
Suffix:
Gender:F
Credentials:MA SSA
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:L
Other - Last Name:LESEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA SSA
Mailing Address - Street 1:277 MAIN ST
Mailing Address - Street 2:ONE WORLD COUNSELING
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-5508
Mailing Address - Country:US
Mailing Address - Phone:508-380-2636
Mailing Address - Fax:508-229-3377
Practice Address - Street 1:277 MAIN ST
Practice Address - Street 2:ONE WORLD COUNSELING
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-5508
Practice Address - Country:US
Practice Address - Phone:508-380-2636
Practice Address - Fax:508-229-3377
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1064191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1894684Medicaid
MA425212OtherHARVARD PILGRIM /PACIFICA
MA310288OtherMHN
MA2031925OtherCIGNA
MAP06286OtherBCBSMA
MA412722OtherMAGELLAN
MA1894684Medicaid