Provider Demographics
NPI:1639819311
Name:MASTROCOLA, MARGUERITE J (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:J
Last Name:MASTROCOLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5347
Mailing Address - Country:US
Mailing Address - Phone:161-731-2547
Mailing Address - Fax:
Practice Address - Street 1:CAMBRIDGE HEALTH ALLIANCE: SOMERVILLE CAMPUS
Practice Address - Street 2:33 TOWER STREET
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143
Practice Address - Country:US
Practice Address - Phone:617-381-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226936104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker