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General NPI Number Information
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NPI Number | 1437264249
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Entity Type | Individual
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Provider Name | DEBORAH A MONGEON LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 105 PINE ST SUITE 1
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City | WALTHAM
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State | MA
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Zip | 02453-5355
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Country | US
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Telephone | 781-893-2462
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Fax |
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Provider Business Mailing Address
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Address Line | 2311 JEFFERSON PL
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City | BELLINGHAM
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State | MA
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Zip | 02019-6301
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Country | US
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Telephone | 508-657-1824
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1032076
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License Number State | MA
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