Provider Demographics
NPI:1689065146
Name:DEERING, MARTHA PEARL (LADC-I)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:PEARL
Last Name:DEERING
Suffix:
Gender:F
Credentials:LADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 GRAFTON ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4017
Mailing Address - Country:US
Mailing Address - Phone:774-239-8092
Mailing Address - Fax:
Practice Address - Street 1:95 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2431
Practice Address - Country:US
Practice Address - Phone:508-453-3053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)