Provider Demographics
NPI:1518006618
Name:AXELROD, NAOMI GERNES (LICSW)
Entity Type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:GERNES
Last Name:AXELROD
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 1:15 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667-7027
Mailing Address - Country:US
Mailing Address - Phone:617-522-5553
Mailing Address - Fax:508-349-2911
Practice Address - Street 1:1368 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2872
Practice Address - Country:US
Practice Address - Phone:617-522-5553
Practice Address - Fax:508-349-2911
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1067521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA711208OtherTUFTS HEALTH PLAN
MAP04510OtherBCBS
MAP04510Medicare ID - Type Unspecified