Provider Demographics
NPI:1790269397
Name:LUDWIG, MARYANNE R (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:R
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 TOTTEN POND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-2026
Mailing Address - Country:US
Mailing Address - Phone:781-894-5330
Mailing Address - Fax:
Practice Address - Street 1:24 MAGNOLIA RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2669
Practice Address - Country:US
Practice Address - Phone:617-512-5573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical