Provider Demographics
NPI:1689712663
Name:TYE, MONA EDEN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:EDEN
Last Name:TYE
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 1:2 DEAN LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1478
Mailing Address - Country:US
Mailing Address - Phone:508-574-2712
Mailing Address - Fax:
Practice Address - Street 1:17 STEVENS ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460-1934
Practice Address - Country:US
Practice Address - Phone:508-574-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1068771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical