1104602002 NPI number — MAUREEN THERESA DEAN MSW MDIV. LCSW

Table of content: MAUREEN THERESA DEAN MSW MDIV. LCSW (NPI 1104602002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104602002 NPI number — MAUREEN THERESA DEAN MSW MDIV. LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEAN
Provider First Name:
MAUREEN
Provider Middle Name:
THERESA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW MDIV. LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104602002
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69 PROSPECT STREET
Provider Second Line Business Mailing Address:
APARTMENT 122
Provider Business Mailing Address City Name:
NORTHAMPTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-614-6088
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 S. PROSPECT STREET
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-341-0085
Provider Business Practice Location Address Fax Number:
413-895-5532
Provider Enumeration Date:
09/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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