Provider Demographics
NPI:1518976422
Name:JOSEPH, MARJORIE GREEN (LICSW, LADC1)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:GREEN
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LICSW, LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHERRYSTONE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-7034
Mailing Address - Country:US
Mailing Address - Phone:508-994-4283
Mailing Address - Fax:
Practice Address - Street 1:386 STANLEY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-6009
Practice Address - Country:US
Practice Address - Phone:508-324-3504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1058231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAFAL2225000710OtherBLU CROSS BLUE SHIELD
MA1306685Medicaid
MAY10284Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER