Healthcare Provider Details

I. General information

NPI: 1649133547
Provider Name (Legal Business Name): TODD JAMES GARVIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FORBES RD STE 190
BRAINTREE MA
02184-2622
US

IV. Provider business mailing address

11 RICHARDSON ST APT 1
MALDEN MA
02148-5245
US

V. Phone/Fax

Practice location:
  • Phone: 781-300-7503
  • Fax:
Mailing address:
  • Phone: 781-300-7503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number222282
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: