Provider Demographics
NPI:1538182209
Name:PERNA, MARCIA SHERMAN (MSW,LICSW)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:SHERMAN
Last Name:PERNA
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 1:450 WASHINGTON ST.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4455
Mailing Address - Country:US
Mailing Address - Phone:781-461-1668
Mailing Address - Fax:781-461-8024
Practice Address - Street 1:450 WASHINGTON ST
Practice Address - Street 2:SUITE 108
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4455
Practice Address - Country:US
Practice Address - Phone:781-461-1668
Practice Address - Fax:781-461-8024
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1544Medicare ID - Type Unspecified