Provider Demographics
NPI:1689702821
Name:HERBERT, MARIE ELIZABETH (LICSW)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELIZABETH
Last Name:HERBERT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 KITTREDGE ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4115
Mailing Address - Country:US
Mailing Address - Phone:617-327-7556
Mailing Address - Fax:
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL, WACC 023
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1059281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical