=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477464048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARIANNE POTVIN, LICSW, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2026
-----------------------------------------------------
Last Update Date | 09/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 CHURCH ST FL 5
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02138-3726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-928-0831
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 CHURCH ST FL 5
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02138-3726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-928-0831
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARIANNE F POTVIN
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 857-928-0831
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------