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NPI Code Detail

MEDICARE: MARYANNE R LUDWIG MSW, LICSW

MEDICARE: MARYANNE R LUDWIG MSW, LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker113069MA

General Provider Information

NPI Number : 1790269397
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYANNE R LUDWIG MSW, LICSW
Provider Business Mailing Address
First Line : 375 TOTTEN POND RD STE 100
Second Line :
City : WALTHAM
State : MA
Zip : 02451-2026
Country : US
Telephone Number : 781-894-5330
Fax Number :
Provider Business Practice Location Address
First Line : 24 MAGNOLIA RD
Second Line :
City : SUDBURY
State : MA
Zip : 01776-2669
Country : US
Telephone Number : 617-512-5573
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2018
Last Update Date : 09/19/2018

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