Healthcare Provider Details

I. General information

NPI: 1013089887
Provider Name (Legal Business Name): MARJORIE PEARSON L.I.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 MAIN ST
WAKEFIELD MA
01880-5013
US

IV. Provider business mailing address

30 MILLER RD
WILMINGTON MA
01887-3512
US

V. Phone/Fax

Practice location:
  • Phone: 781-246-2010
  • Fax:
Mailing address:
  • Phone: 978-988-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1025931
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: