Healthcare Provider Details

I. General information

NPI: 1184270225
Provider Name (Legal Business Name): WILLIAM CODY LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 FAIRVIEW ST
DEDHAM MA
02026-3254
US

IV. Provider business mailing address

46 FAIRVIEW ST
DEDHAM MA
02026-3254
US

V. Phone/Fax

Practice location:
  • Phone: 724-747-3934
  • Fax:
Mailing address:
  • Phone: 724-747-3934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1140684
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: