Provider Demographics
NPI:1023101011
Name:SAVINO, MARK (LICSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:SAVINO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JOANNE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1299
Mailing Address - Country:US
Mailing Address - Phone:508-748-3649
Mailing Address - Fax:
Practice Address - Street 1:52 BRIGHAM ST
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2210
Practice Address - Country:US
Practice Address - Phone:508-993-8332
Practice Address - Fax:508-993-1024
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10224881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1857916Medicaid
MA1857916Medicaid