Provider Demographics
NPI:1447685797
Name:ATWATER, ANNE (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:ATWATER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 ELM ST STE B1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-3150
Mailing Address - Country:US
Mailing Address - Phone:617-362-8704
Mailing Address - Fax:
Practice Address - Street 1:175 ELM ST STE B1
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-3150
Practice Address - Country:US
Practice Address - Phone:617-894-1838
Practice Address - Fax:617-254-5539
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA125898104100000X, 1041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical