Provider Demographics
NPI:1710189113
Name:GARVIN, THERESA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:GARVIN
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 1:18 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2629
Mailing Address - Country:US
Mailing Address - Phone:978-287-0810
Mailing Address - Fax:978-287-5566
Practice Address - Street 1:142 NORTH RD
Practice Address - Street 2:F-105
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1142
Practice Address - Country:US
Practice Address - Phone:978-287-0810
Practice Address - Fax:978-287-5566
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10248951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1024895OtherMA LICSW LIC.#