Provider Demographics
NPI:1154425668
Name:MARGOLIS, BRIAN (LICSW)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MARGOLIS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MAIN ST
Mailing Address - Street 2:COOLEY DICKINSON HOSPITAL - OPT BEHAVIORAL HEALTH
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3158
Mailing Address - Country:US
Mailing Address - Phone:413-586-8550
Mailing Address - Fax:413-586-9765
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:COOLEY DICKINSON HOSPITAL - OPT BEHAVIORAL HEALTH
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-3158
Practice Address - Country:US
Practice Address - Phone:413-586-8550
Practice Address - Fax:413-586-9765
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101541811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23220Medicare ID - Type Unspecified