Basic Information
| Provider Information | |||||||||
| NPI: | 1861524704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANTOR | ||||||||
| FirstName: | MARLENE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 362 N BEDFORD ST | ||||||||
| Address2: | |||||||||
| City: | EAST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023331148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083502350 | ||||||||
| FaxNumber: | 5083502318 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 BRISTOL DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH EASTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023751199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817675552 | ||||||||
| FaxNumber: | 7819828752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 06/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 115934 | MA | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 1861524704 | 01 | MA | CIGNA | OTHER | 1861524704 | 01 | MA | TUFTS | OTHER | 1861524704 | 01 | MA | BC/BS | OTHER |