| Doctor Name: | MARK CHERUBIM |
| NPI Number: | 1417016965 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LICSW |
| License Number: | 112081 |
| Business Practice Address: | 155a Lovering St Medway, MA - 020532331 |
| Business Phone Number: | 5085238736 |
| Business Fax Number: | 5085334103 |
| Mailing Address: | 155a Lovering Street, MEDWAY |
| State: | MA |
| Postal Code: | 02053 |
| Phone Number: | 5085238736 |
| Fax Number: | 5085334103 |
| NPI Enumeration Date: | 12/08/2006 |
| NPI Last Update Date: | 06/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 112081 |
| 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 |