Provider Demographics
NPI:1740377910
Name:FROMM, MARC (LICSW)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:FROMM
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:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:HAYDENVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01039-0491
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:132 MAIN ST.
Practice Address - Street 2:
Practice Address - City:HAYDENVILLE
Practice Address - State:MA
Practice Address - Zip Code:01039
Practice Address - Country:US
Practice Address - Phone:413-268-9967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10313791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical