Provider Demographics
NPI:1871655464
Name:URBAN, MARY H (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:H
Last Name:URBAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 FISHER AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-3340
Mailing Address - Country:US
Mailing Address - Phone:617-730-9595
Mailing Address - Fax:617-277-4341
Practice Address - Street 1:210 FISHER AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-3340
Practice Address - Country:US
Practice Address - Phone:617-730-9595
Practice Address - Fax:617-277-4341
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1045131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO2646OtherBLUE CROSSBLUESHIELD
MAUR P22202Medicare ID - Type Unspecified