Provider Demographics
NPI:1689128183
Name:TARVIN, MARY C (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:TARVIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 BYRNE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1703
Mailing Address - Country:US
Mailing Address - Phone:617-696-4791
Mailing Address - Fax:617-507-8354
Practice Address - Street 1:1 WALPOLE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3315
Practice Address - Country:US
Practice Address - Phone:781-414-2247
Practice Address - Fax:781-352-3996
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1146471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical