MEDICARE: EMERSON FANG 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1235866344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMERSON FANG LICSW

Provider Business Mailing Address
First Line	:	234 COPELAND ST STE 320
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-4082
Country	:	US
Telephone Number	:	617-479-4545
Fax Number	:	617-481-5296

Provider Business Practice Location Address
First Line	:	234 COPELAND ST STE 320
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-4082
Country	:	US
Telephone Number	:	617-479-4545
Fax Number	:	617-481-5296

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

Provider Enumeration Date	:	08/08/2022
Last Update Date	:	04/27/2023

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