Provider Demographics
NPI:1114011160
Name:PRUGH, JOAN E (MSW,LICSW)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:PRUGH
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BREWSTER ST
Mailing Address - Street 2:
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657-1603
Mailing Address - Country:US
Mailing Address - Phone:860-450-9789
Mailing Address - Fax:
Practice Address - Street 1:17 BREWSTER ST
Practice Address - Street 2:
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-1603
Practice Address - Country:US
Practice Address - Phone:860-450-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0005311041C0700X
MA1160081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical