Provider Demographics
NPI:1447946223
Name:SECCOMBE, MARILYN F (LMHC, MASS #508)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:F
Last Name:SECCOMBE
Suffix:
Gender:F
Credentials:LMHC, MASS #508
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 OLD NUGENT FARM RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3169
Mailing Address - Country:US
Mailing Address - Phone:978-273-9225
Mailing Address - Fax:
Practice Address - Street 1:52 OLD NUGENT FARM RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-3169
Practice Address - Country:US
Practice Address - Phone:978-273-9225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA508101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty