Provider Demographics
NPI:1134863475
Name:WEISENFELD, MARIAN R (LICSW)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:R
Last Name:WEISENFELD
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 1:52 DICKSON AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-2042
Mailing Address - Country:US
Mailing Address - Phone:781-771-4003
Mailing Address - Fax:781-646-1085
Practice Address - Street 1:52 DICKSON AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-2042
Practice Address - Country:US
Practice Address - Phone:781-771-4003
Practice Address - Fax:781-646-1085
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10312961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical