Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 1024153 | MA |
NPI | 1003127200 |
---|---|
Provider Name | Michael G Durben |
First Address | Ayer, MA 01432-1558 |
Second Address | Worcester, MA 01605-2106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 23/06/2010 |