Provider Demographics
NPI:1720524507
Name:SENNER, EVA RAY (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:RAY
Last Name:SENNER
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 1:707 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1013
Mailing Address - Country:US
Mailing Address - Phone:978-505-5212
Mailing Address - Fax:
Practice Address - Street 1:707 FULTON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1013
Practice Address - Country:US
Practice Address - Phone:978-505-5212
Practice Address - Fax:617-326-3021
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1260951041C0700X
MA0002223291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical