Provider Demographics
NPI:1992826267
Name:PEARLMUTTER, MADELINE DYMSZA (MSW)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:DYMSZA
Last Name:PEARLMUTTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6005
Mailing Address - Country:US
Mailing Address - Phone:617-732-7842
Mailing Address - Fax:617-975-0828
Practice Address - Street 1:440 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6005
Practice Address - Country:US
Practice Address - Phone:617-732-7842
Practice Address - Fax:617-975-0828
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10215501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical