Provider Demographics
NPI:1306978325
Name:SCHIFFER, MARY JANE (LICSW)
Entity type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:SCHIFFER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5450
Mailing Address - Country:US
Mailing Address - Phone:781-235-4832
Mailing Address - Fax:781-237-9620
Practice Address - Street 1:30 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1527
Practice Address - Country:US
Practice Address - Phone:781-235-4832
Practice Address - Fax:781-237-9620
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10180281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1859684Medicaid
MAPO5100OtherBLUE CROSS BLUE SHIELD
MAPO5100Medicare ID - Type Unspecified