Provider Demographics
NPI:1962525881
Name:MARPLE, MARY KATE (LICSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATE
Last Name:MARPLE
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 1:71 GILRAIN TER
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3430
Mailing Address - Country:US
Mailing Address - Phone:413-781-3307
Mailing Address - Fax:413-781-3315
Practice Address - Street 1:201 PARK AVE
Practice Address - Street 2:
Practice Address - City:W SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3366
Practice Address - Country:US
Practice Address - Phone:413-781-3307
Practice Address - Fax:413-781-3315
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1065751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA32394OtherHEALTH NEW ENGLAND
MAP04565OtherBCBS
MA000000026323Medicaid
MAMAGELLENOther408490
MAMAGELLENOther408490