Healthcare Provider Details

I. General information

NPI: 1730806167
Provider Name (Legal Business Name): DAVID SAMUEL WHITE MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 FURNACE BROOK PKWY STE 2230
QUINCY MA
02169-4721
US

IV. Provider business mailing address

30 HOLDEN ST
CAMBRIDGE MA
02138-2069
US

V. Phone/Fax

Practice location:
  • Phone: 617-479-4545
  • Fax:
Mailing address:
  • Phone: 857-949-6014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number227079
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: