Provider Demographics
NPI:1659887479
Name:KILLOUGH, MARLA R (MSW)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:R
Last Name:KILLOUGH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 PELHAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHUTESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01072-9702
Mailing Address - Country:US
Mailing Address - Phone:413-259-1448
Mailing Address - Fax:
Practice Address - Street 1:164 HIGH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2613
Practice Address - Country:US
Practice Address - Phone:413-773-2675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10211361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical