Healthcare Provider Details

I. General information

NPI: 1134602196
Provider Name (Legal Business Name): MICILEEN MCGRATH LCISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E NEWTON ST
BOSTON MA
02118-3553
US

IV. Provider business mailing address

293 SILVER STREET
SOUTH BOSTON MA
02127
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-8336
  • Fax:
Mailing address:
  • Phone: 617-970-3799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW225652
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: