Healthcare Provider Details

I. General information

NPI: 1801953989
Provider Name (Legal Business Name): MATTHEW JOSEPH MCCALL M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WARREN ST BUILDING 9
BRIGHTON MA
02135-3601
US

IV. Provider business mailing address

15 SANDERSON AVE LEFT
DEDHAM MA
02026-3313
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-0964
  • Fax: 617-789-5496
Mailing address:
  • Phone: 617-469-8572
  • Fax: 617-469-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: