Healthcare Provider Details

I. General information

NPI: 1063284313
Provider Name (Legal Business Name): HAN N CAO MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST YAWKEY 2
BOSTON MA
02114-3117
US

IV. Provider business mailing address

55 FRUIT ST YAWKEY 2
BOSTON MA
02114-2696
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-0175
  • Fax:
Mailing address:
  • Phone: 617-724-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127370
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: