=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427526292
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA MARIE MAYFIELD MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2018
-----------------------------------------------------
Last Update Date | 11/09/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1550 BEACON ST
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02446-2247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-363-8028
-----------------------------------------------------
Fax | 617-879-0223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1550 BEACON ST
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02446-2247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-363-8028
-----------------------------------------------------
Fax | 617-879-0223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 222199
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------