Provider Demographics
NPI:1821186693
Name:ENGRAM, MARC (LICSW)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:ENGRAM
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 PELHAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHUTESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01072-9748
Mailing Address - Country:US
Mailing Address - Phone:413-587-0444
Mailing Address - Fax:
Practice Address - Street 1:200 MAIN ST STE 2A
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3170
Practice Address - Country:US
Practice Address - Phone:413-587-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10235611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical