MEDICARE: MR. JOHN SACCO LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	114812	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356365266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN SACCO LICSW

Provider Business Mailing Address
First Line	:	2A GREEN HILL ST
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02122-3515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2A GREEN HILL ST
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02122-3515
Country	:	US
Telephone Number	:	617-602-6049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	09/18/2009

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