Provider Demographics
NPI:1942782263
Name:ULIVI, MIRTA SUSANA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MIRTA
Middle Name:SUSANA
Last Name:ULIVI
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 1:27 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1859
Mailing Address - Country:US
Mailing Address - Phone:978-317-2391
Mailing Address - Fax:
Practice Address - Street 1:45 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5579
Practice Address - Country:US
Practice Address - Phone:978-825-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty