Healthcare Provider Details

I. General information

NPI: 1144631433
Provider Name (Legal Business Name): DEBORAH SCARSELLETTA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 GARRISON RD
BROOKLINE MA
02445-4445
US

IV. Provider business mailing address

41 GARRISON RD
BROOKLINE MA
02445-4445
US

V. Phone/Fax

Practice location:
  • Phone: 617-277-8107
  • Fax:
Mailing address:
  • Phone: 617-277-8107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117820
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: