Healthcare Provider Details

I. General information

NPI: 1477464048
Provider Name (Legal Business Name): MARIANNE POTVIN, LICSW, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CHURCH ST FL 5
CAMBRIDGE MA
02138-3726
US

IV. Provider business mailing address

50 CHURCH ST FL 5
CAMBRIDGE MA
02138-3726
US

V. Phone/Fax

Practice location:
  • Phone: 857-928-0831
  • Fax:
Mailing address:
  • Phone: 857-928-0831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARIANNE F POTVIN
Title or Position: PRESIDENT
Credential: LICSW
Phone: 857-928-0831