Provider Demographics
NPI:1689880718
Name:CARDANI, MARYANN WRENN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:WRENN
Last Name:CARDANI
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 1:41 IRETA RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-1714
Mailing Address - Country:US
Mailing Address - Phone:508-842-4225
Mailing Address - Fax:
Practice Address - Street 1:475 FRANKLIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6264
Practice Address - Country:US
Practice Address - Phone:508-875-3100
Practice Address - Fax:508-875-4373
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10226621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACA P211109Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID