Doctor Name: | MARY E TICKNOR |
NPI Number: | 1003857079 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LICSW |
License Number: | 113177 |
Business Practice Address: | 57 Gothic St Northampton, MA - 010603047 |
Business Phone Number: | 4135840110 |
Business Fax Number: | 4135840027 |
Mailing Address: | 57 Gothic St, NORTHAMPTON |
State: | MA |
Postal Code: | 010603047 |
Phone Number: | 4135840110 |
Fax Number: | 4135840027 |
NPI Enumeration Date: | 06/09/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 113177 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |