Provider Demographics
NPI:1699857276
Name:IRWIN, MARTHA E (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:E
Last Name:IRWIN
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 1:26 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1608
Mailing Address - Country:US
Mailing Address - Phone:617-628-7255
Mailing Address - Fax:617-628-2779
Practice Address - Street 1:26 OXFORD ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1608
Practice Address - Country:US
Practice Address - Phone:617-628-7255
Practice Address - Fax:617-628-2779
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1002401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical