Provider Demographics
NPI:1962562728
Name:ANDRADE SERPA, MARCIA (LICSW)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:ANDRADE SERPA
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 1:60 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4314
Mailing Address - Country:US
Mailing Address - Phone:508-580-7950
Mailing Address - Fax:508-580-7956
Practice Address - Street 1:60 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4314
Practice Address - Country:US
Practice Address - Phone:508-580-7950
Practice Address - Fax:508-580-7956
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10321401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical