Provider Demographics
NPI:1891719969
Name:GEORGE, JOANNE S (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:S
Last Name:GEORGE
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 1:60 MAPLE ST APT A
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2975
Mailing Address - Country:US
Mailing Address - Phone:781-821-9343
Mailing Address - Fax:
Practice Address - Street 1:62 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-0336
Practice Address - Country:US
Practice Address - Phone:781-784-1700
Practice Address - Fax:781-784-4602
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1028901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGEP23621Medicare ID - Type UnspecifiedMEDICARE