Healthcare Provider Details

I. General information

NPI: 1720476724
Provider Name (Legal Business Name): JOHN TOWER LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 PARK AVE
WORCESTER MA
01603-2537
US

IV. Provider business mailing address

125 JOHN REZZA DR
NORTH ATTLEBORO MA
02763-4023
US

V. Phone/Fax

Practice location:
  • Phone: 650-636-6974
  • Fax:
Mailing address:
  • Phone: 650-636-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118112
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: