Provider Demographics
NPI:1962503755
Name:DWYER, MARION RICHMOND (LICSW)
Entity type:Individual
Prefix:MRS
First Name:MARION
Middle Name:RICHMOND
Last Name:DWYER
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 1:91 PARTING ROCK RD
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-3214
Mailing Address - Country:US
Mailing Address - Phone:781-837-3589
Mailing Address - Fax:
Practice Address - Street 1:20 TREMONT ST
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-5310
Practice Address - Country:US
Practice Address - Phone:781-934-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1550OtherBLUE CROSS BLUE SHIELD ID