Provider Demographics
NPI:1801834874
Name:DITTMER, NATHAN (LICSW)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:DITTMER
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 1:7 MARSHALL ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-1542
Mailing Address - Country:US
Mailing Address - Phone:978-365-3808
Mailing Address - Fax:
Practice Address - Street 1:400 GROVE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1271
Practice Address - Country:US
Practice Address - Phone:508-755-4485
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1105851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical