Healthcare Provider Details

I. General information

NPI: 1720709041
Provider Name (Legal Business Name): MARIA WHITE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RESERVOIR ST STE 21AND28
NEEDHAM MA
02494-3149
US

IV. Provider business mailing address

115 SPRUCE ST
WATERTOWN MA
02472-1991
US

V. Phone/Fax

Practice location:
  • Phone: 781-429-7755
  • Fax:
Mailing address:
  • Phone: 617-458-9014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

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: