Provider Demographics
NPI:1982732327
Name:PARK, ANN EWADE (LICSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:EWADE
Last Name:PARK
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 1:147 NORTHWEST RD
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-9541
Mailing Address - Country:US
Mailing Address - Phone:413-527-6398
Mailing Address - Fax:
Practice Address - Street 1:ADCARE HOSPITAL OF WORCESTER,INC
Practice Address - Street 2:117 PARK AVE,SUITE 2
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089
Practice Address - Country:US
Practice Address - Phone:413-209-3124
Practice Address - Fax:413-209-3127
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110055101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor