Provider Demographics
NPI:1538159082
Name:PURDY, ANN H (LICSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:H
Last Name:PURDY
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 1:41 MONTVALE AVE
Mailing Address - Street 2:HALLMARK HEALTH HEMATOLOGY & ONCOLOGY CLINIC
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2445
Mailing Address - Country:US
Mailing Address - Phone:781-224-5810
Mailing Address - Fax:781-224-5813
Practice Address - Street 1:41 MONTVALE AVE
Practice Address - Street 2:HALLMARK HEALTH HEMATOLOGY & ONCOLOGY CLINIC
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2445
Practice Address - Country:US
Practice Address - Phone:781-224-5810
Practice Address - Fax:781-224-5813
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10209061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200992Medicaid
MA1200992Medicaid