Healthcare Provider Details

I. General information

NPI: 1326108853
Provider Name (Legal Business Name): RONALD TRIEFF LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERRIMAC LANDING SUITE 11
NEWBURYPORT MA
01950
US

IV. Provider business mailing address

1 MERRIMAC LANDING SUITE 11
NEWBURYPORT MA
01950
US

V. Phone/Fax

Practice location:
  • Phone: 978-462-0498
  • Fax: 978-463-0009
Mailing address:
  • Phone: 978-462-0498
  • Fax: 978-463-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100886
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: