Provider Demographics
NPI:1427526292
Name:MAYFIELD, REBECCA MARIE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2247
Mailing Address - Country:US
Mailing Address - Phone:617-363-8028
Mailing Address - Fax:617-879-0223
Practice Address - Street 1:1550 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2247
Practice Address - Country:US
Practice Address - Phone:617-363-8028
Practice Address - Fax:617-879-0223
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222199104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker