Provider Demographics
NPI:1912329244
Name:MANN, MAUREEN C (LICSW, EMP, RMT)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:C
Last Name:MANN
Suffix:
Gender:F
Credentials:LICSW, EMP, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KNOTTS ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-1783
Mailing Address - Country:US
Mailing Address - Phone:508-738-0111
Mailing Address - Fax:
Practice Address - Street 1:69 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2122
Practice Address - Country:US
Practice Address - Phone:978-310-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110942101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health