Provider Demographics
NPI:1649753542
Name:BRUNDAGE, MARGARET (LICSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:BRUNDAGE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:BRUNDAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:31 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-5913
Mailing Address - Country:US
Mailing Address - Phone:781-488-8888
Mailing Address - Fax:
Practice Address - Street 1:31 LINDEN ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-5913
Practice Address - Country:US
Practice Address - Phone:781-648-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1058851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA105885OtherLICSW