Provider Demographics
NPI:1952470379
Name:POWERS, GRETCHEN HAZEN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:HAZEN
Last Name:POWERS
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 1:168 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-2001
Mailing Address - Country:US
Mailing Address - Phone:508-207-5495
Mailing Address - Fax:508-429-6353
Practice Address - Street 1:118 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1373
Practice Address - Country:US
Practice Address - Phone:508-207-5495
Practice Address - Fax:508-429-6353
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1101371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO P23045Medicare ID - Type Unspecified
P08134Medicare UPIN
015245Medicare UPIN
1034220Medicare UPIN