Provider Demographics
NPI:1588148746
Name:HARTY, MAUREEN ELIZABETH (LICSW)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:HARTY
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 1:73 FENNO ST APT 14
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-3925
Mailing Address - Country:US
Mailing Address - Phone:617-953-6032
Mailing Address - Fax:
Practice Address - Street 1:3 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3715
Practice Address - Country:US
Practice Address - Phone:617-864-2580
Practice Address - Fax:617-492-1080
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111135-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical