Provider Demographics
NPI:1104602002
Name:DEAN, MAUREEN THERESA (MSW MDIV LCSW)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:THERESA
Last Name:DEAN
Suffix:
Gender:F
Credentials:MSW MDIV LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 PROSPECT STREET
Mailing Address - Street 2:APARTMENT 122
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:310-614-6088
Mailing Address - Fax:
Practice Address - Street 1:26 S. PROSPECT STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002
Practice Address - Country:US
Practice Address - Phone:413-341-0085
Practice Address - Fax:413-895-5532
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical