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NPI Code Detail

MEDICARE: MR. MATTHEW JOHN DISCHINGER LICSW

MEDICARE: MR. MATTHEW JOHN DISCHINGER 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1467749010
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW JOHN DISCHINGER LICSW
Provider Business Mailing Address
First Line : 4 BLACKBURN CTR
Second Line :
City : GLOUCESTER
State : MA
Zip : 01930-2268
Country : US
Telephone Number : 978-283-7198
Fax Number :
Provider Business Practice Location Address
First Line : 4 BLACKBURN CTR
Second Line :
City : GLOUCESTER
State : MA
Zip : 01930-2268
Country : US
Telephone Number : 978-281-7793
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2011
Last Update Date : 03/28/2024

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