MEDICARE: DANIEL G MENDELSOHN 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
1	1041S0200X	School Social Worker

General Provider Information

NPI Number	:	1083374342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL G MENDELSOHN LICSW

Provider Business Mailing Address
First Line	:	51 JUGGLER MEADOW RD
Second Line	:
City	:	LEVERETT
State	:	MA
Zip	:	01054-9521
Country	:	US
Telephone Number	:	617-304-0094
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 JUGGLER MEADOW RD
Second Line	:
City	:	LEVERETT
State	:	MA
Zip	:	01054-9521
Country	:	US
Telephone Number	:	617-304-0094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2021
Last Update Date	:	12/28/2021

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