Healthcare Provider Details

I. General information

NPI: 1730011511
Provider Name (Legal Business Name): MARYBETH TODD LICSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MAIN ST
NORTHBOROUGH MA
01532-1942
US

IV. Provider business mailing address

12 KING ST
FITCHBURG MA
01420-4128
US

V. Phone/Fax

Practice location:
  • Phone: 508-475-7697
  • Fax:
Mailing address:
  • Phone: 508-475-7697
  • 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: MARYBETH TODD
Title or Position: PSYCHOTHERAPIST
Credential: LICSW
Phone: 508-475-7697