Provider Demographics
NPI:1821254715
Name:DAVIDOWITZ, MITCHELL MARK (LICSW SOCIAL WORKER)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:MARK
Last Name:DAVIDOWITZ
Suffix:
Gender:M
Credentials:LICSW SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LOCKELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6318
Mailing Address - Country:US
Mailing Address - Phone:781-223-5879
Mailing Address - Fax:617-489-6125
Practice Address - Street 1:94 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-6535
Practice Address - Country:US
Practice Address - Phone:781-223-5879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1143751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA114375OtherCOMMONWEALTH OF MASS LICSW LICENSE NUMBER