Healthcare Provider Details

I. General information

NPI: 1730346735
Provider Name (Legal Business Name): JOAN MARIE CREMINS L.I.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 COUNTY RD
MATTAPOISETT MA
02739-1652
US

IV. Provider business mailing address

53 COUNTY ROAD PO BOX 166
MATTAPOISETT MA
02739-1901
US

V. Phone/Fax

Practice location:
  • Phone: 508-266-5353
  • Fax: 508-758-1332
Mailing address:
  • Phone: 508-266-5353
  • Fax: 508-758-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1021884
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: