Individual ProviderAllen Mark SpivackSocial WorkerBehavioral Health & Social Service ProvidersPractice Address55 Dimock St, Room 309, Roxbury, MA 02119-1029(617) 442-8800PECOS EnrollmentBased on the most recent information from CMS, provider Allen Mark Spivack does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 12:07 PM.Profile DetailsProvider ID1417240706Provider TypeIndividualFull NameSpivack, Allen MarkTitleMr.CredentialLICSWGenderMaleSole ProprietorYesEnumeration Date5/19/2011Last Updated5/19/2011Contact InformationPractice LocationPractice Address55 Dimock St, Room 309, Roxbury, MA 02119-1029Phone(617) 442-8800Fax(617) 427-1126Mailing LocationMailing Address55 Dimock St, Room 309, Roxbury, MA 02119-1029Phone(617) 442-8800Fax(617) 427-1126Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense1029802Massachusetts