Provider Demographics
NPI:1134212996
Name:MACKINNON, ANN MARIE D (LICSW)
Entity type:Individual
Prefix:MS
First Name:ANN MARIE
Middle Name:D
Last Name:MACKINNON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:ANN MARIE
Other - Middle Name:
Other - Last Name:DANAHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:475 SCHOOL STREET SUITE 14-17
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050
Mailing Address - Country:US
Mailing Address - Phone:781-834-0747
Mailing Address - Fax:
Practice Address - Street 1:475 SCHOOL STREET SUITE 14-17
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050
Practice Address - Country:US
Practice Address - Phone:781-834-0747
Practice Address - Fax:781-834-0763
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADA-P23988Medicare UPIN