Healthcare Provider Details

I. General information

NPI: 1871709709
Provider Name (Legal Business Name): JOANNE SEWELL LCSW, LADC1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PORTER ST
EAST BOSTON MA
02128-2116
US

IV. Provider business mailing address

5050 WASHINGTON ST APT 333
WEST ROXBURY MA
02132-4744
US

V. Phone/Fax

Practice location:
  • Phone: 617-314-4359
  • Fax:
Mailing address:
  • Phone: 617-314-4359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number213828
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: