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NPI Code Detail

MEDICARE: AMY LYNN WHITTEMORE MSW, LICSW

MEDICARE: AMY LYNN WHITTEMORE MSW, LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker110370MA

General Provider Information

NPI Number : 1033280771
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY LYNN WHITTEMORE MSW, LICSW
Provider Business Mailing Address
First Line : 53 WEST ST
Second Line :
City : NEWTON
State : MA
Zip : 02458-1349
Country : US
Telephone Number : 617-969-4925
Fax Number : 617-244-2507
Provider Business Practice Location Address
First Line : 64 ELDREDGE ST
Second Line :
City : NEWTON
State : MA
Zip : 02458-2017
Country : US
Telephone Number : 617-969-4925
Fax Number : 617-244-2507
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 07/08/2007

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