MEDICARE: HENRY WHITE

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	228419	MA

General Provider Information

NPI Number	:	1386392413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY WHITE

Provider Business Mailing Address
First Line	:	56 BOWER ST # 1
Second Line	:
City	:	MEDFORD
State	:	MA
Zip	:	02155-3662
Country	:	US
Telephone Number	:	508-269-0879
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 NORTH ST
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02144-1418
Country	:	US
Telephone Number	:	508-269-0879
Fax Number	:

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

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	01/27/2026

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Directions to “ HENRY WHITE ” Practice Location

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