Provider Demographics
NPI:1700917051
Name:DURGIN, MARK C (LICSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:DURGIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:S HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-1435
Mailing Address - Country:US
Mailing Address - Phone:978-468-1622
Mailing Address - Fax:978-468-1622
Practice Address - Street 1:293 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:S HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-1435
Practice Address - Country:US
Practice Address - Phone:978-468-1622
Practice Address - Fax:978-468-1622
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10179721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADU P22432Medicare ID - Type Unspecified