Provider Demographics
NPI:1205055811
Name:ENGELS, MARY (LICSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:ENGELS
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 1:119 FREE ST.
Mailing Address - Street 2:175 DERBY ST SUITE 10
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:617-827-0746
Mailing Address - Fax:
Practice Address - Street 1:119 FREE ST
Practice Address - Street 2:175 DERBY ST. SUITE 10
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3203
Practice Address - Country:US
Practice Address - Phone:617-827-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10175071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical