Provider Demographics
NPI:1871898403
Name:LONGVAL-HARNISH, MARYBETH (LICSW)
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:LONGVAL-HARNISH
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 1:2016 OCEAN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-3115
Mailing Address - Country:US
Mailing Address - Phone:781-361-0927
Mailing Address - Fax:
Practice Address - Street 1:2016 OCEAN ST STE 3
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-3115
Practice Address - Country:US
Practice Address - Phone:781-361-0927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116637104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker