Mary Ellen Henry, PH.D.,LICSW
Individual provider Active NPI Clinical Social Worker · Provincetown, MA
NPI 1659415396 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1659415396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 1028357 (MA)
- Practice address
- 50 Commercial St
Provincetown, MA 02657-1912 - Phone
- (508) 487-2698
- NPI assigned
- Feb 16, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1028357 | MA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1028357 | MA | Yes |
Addresses
Primary practice location
50 Commercial St
Provincetown, MA 02657-1912
Mailing address
50 Commercial St
Provincetown, MA 02657-1912
Phone (508) 487-2698
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P07319 | Other | MA | BLUE CROSS PROVIDER NUMBE |
| 1858483 | Other | MA | MASSHEALTH PROVIDER NUMBE |
| 1894862 | Medicaid | MA |
Other providers in Provincetown, MA
- Mahrya Katrinka Hart
- Kristin C. Hatch
- Walter James Healey
- Donna Kathreen Heitzman
- Michael Sentman Henderson
- Mary Ann Hibino
- Honest Pharmacist Inc
- Arthur Januario
- Andrew Carl Jorgensen
- Donna Moffat Krauth
All providers in Provincetown, MA · Clinical Social Worker in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.