| Mark Deyab Licsw Inc | |
|
1 W Foster St 3rd Floor Melrose MA 02176-3847 | |
| (781) 799-3949 | |
| (781) 665-0027 |
| Full Name | Mark Deyab Licsw Inc |
|---|---|
| Speciality | Social Worker |
| Location | 1 W Foster St, Melrose, Massachusetts |
| Authorized Official Name and Position | Mark Deyab (PSYCHOTHERAPIST) |
| Authorized Official Contact | 7817993949 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Deyab Licsw Inc 34 Wareham St Apt. 1 Medford MA 02155-6222 Ph: (781) 799-3949 | Mark Deyab Licsw Inc 1 W Foster St 3rd Floor Melrose MA 02176-3847 Ph: (781) 799-3949 |
| NPI Number | 1750715108 |
|---|---|
| Provider Enumeration Date | 08/21/2013 |
| Last Update Date | 08/21/2013 |
| Medicare PECOS PAC ID | 9739302456 |
|---|---|
| Medicare Enrollment ID | O20140528001190 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750715108 | NPI | - | NPPES |
| 1104907732 | Other | MA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 111824 (Massachusetts) | Primary |
| Provider Name | Mark A Deyab |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104907732 PECOS PAC ID: 8921065368 Enrollment ID: I20041216000816 |
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