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General NPI Number Information
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NPI Number | 1689128183
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Entity Type | Individual
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Provider Name | MARY C. TARVIN LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 08/13/2016
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Provider Practice Location Address
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Address Line | 1 WALPOLE ST SUITE 1
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City | NORWOOD
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State | MA
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Zip | 02062-3315
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Country | US
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Telephone | 781-414-2247
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Fax | 781-352-3996
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Provider Business Mailing Address
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Address Line | 5 BYRNE RD
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City | MILTON
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State | MA
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Zip | 02186-1703
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Country | US
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Telephone | 617-696-4791
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Fax | 617-507-8354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 114647
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License Number State | MA
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