Individual
AVA PARENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1 BROOKLINE PL, BROOKLINE, MA 02445-7224
(617) 405-5735
Mailing address
1 BROOKLINE PL, BROOKLINE, MA 02445-7224
(617) 405-5735
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LICSW1141383
MA
Other
Enumeration date
09/15/2021
Last updated
09/04/2025
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