Provider Demographics
NPI:1124270897
Name:MCCURLEY, MARY ELLEN (LICSW,MPH)
Entity type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:MCCURLEY
Suffix:
Gender:F
Credentials:LICSW,MPH
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:MCCURLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW,MPH
Mailing Address - Street 1:8 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2314
Mailing Address - Country:US
Mailing Address - Phone:617-548-1943
Mailing Address - Fax:978-255-2767
Practice Address - Street 1:2 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-5726
Practice Address - Country:US
Practice Address - Phone:617-548-1943
Practice Address - Fax:978-255-2767
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1148471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0021532Medicare PIN