Provider Demographics
NPI:1801903620
Name:CAWLEY, THEODORA E (LICSW)
Entity type:Individual
Prefix:MS
First Name:THEODORA
Middle Name:E
Last Name:CAWLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:THEA
Other - Middle Name:E
Other - Last Name:CAWLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:841 MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2997
Mailing Address - Country:US
Mailing Address - Phone:508-668-3284
Mailing Address - Fax:508-668-3381
Practice Address - Street 1:841 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2997
Practice Address - Country:US
Practice Address - Phone:508-668-3284
Practice Address - Fax:508-668-3381
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10207481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7202293OtherAETNA HEALTHCARE
030463113-02OtherPACIFICARE BEHAVIORAL HEA
7202293OtherAETNA HEALTHCARE