Allen Mark Spivack LICSW

NPI 1417240706 - Social Worker - 1041C0700X

NPI Details
NPI 1417240706
Gender Male
Enumeration Date 05/19/2011
Last Updated 05/19/2011
Entity Type Individual
Active Over 6 years ago
Practice Location
55 DIMOCK ST
ROOM 309
ROXBURY MA, 02119-1029, US
Phone (617) 442-8800
Fax (617) 427-1126
Business Location
55 DIMOCK ST
ROOM 309
ROXBURY MA, 02119-1029, US
Phone (617) 442-8800
Fax (617) 427-1126
Toxanomy
Taxonomy Code 1041C0700X
License State Massachusetts
License Number 1029802
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According to our database, Mr. Allen Mark Spivack LICSW NPI is 1417240706, taxonomy code is 1041C0700X and license number is 1029802, license state is located at Massachusetts. Allen Mark Spivack LICSW physically located at 55 Dimock St, Roxbury MA, 02119-1029. NPI Number Allen Mark Spivack LICSW has the Individual type.

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1417240706 NPI number is provided on an as is basis without warranty of any kind. 1417240706 is maintained by the National Plan & Provider Enumeration System. The contents of Allen Mark Spivack LICSW are for informational purposes only.