1245734573 NPI number — MARIECA CATHRYN DAVIEAU MSW, LICSW, CCM

Table of content: MARIECA CATHRYN DAVIEAU MSW, LICSW, CCM (NPI 1245734573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245734573 NPI number — MARIECA CATHRYN DAVIEAU MSW, LICSW, CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIEAU
Provider First Name:
MARIECA
Provider Middle Name:
CATHRYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW, CCM
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:
1245734573
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 HARTSHORN AVE APT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01602-2904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-890-6407
Provider Business Mailing Address Fax Number:
508-890-6410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 PRESCOTT ST STE 3300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01605-2652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-890-6400
Provider Business Practice Location Address Fax Number:
508-890-6410
Provider Enumeration Date:
03/21/2018

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 , with the licence number:  1029379 , 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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