Provider Demographics
NPI:1912931551
Name:MORDINI, BARBARA A (LICSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:A
Last Name:MORDINI
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 1:21 TOTMAN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7564
Mailing Address - Country:US
Mailing Address - Phone:617-471-6322
Mailing Address - Fax:617-471-6327
Practice Address - Street 1:21 TOTMAN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7564
Practice Address - Country:US
Practice Address - Phone:617-471-6322
Practice Address - Fax:617-471-6327
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10180181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO6271Medicare UPIN