MEDICARE: RUN FENG 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	122189	MA

General Provider Information

NPI Number	:	1720633506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUN FENG LICSW

Provider Business Mailing Address
First Line	:	1131 BEACON ST STE 1-C
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02446-5531
Country	:	US
Telephone Number	:	617-906-6176
Fax Number	:	617-906-6177

Provider Business Practice Location Address
First Line	:	1131 BEACON ST STE 1-C
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02446-5531
Country	:	US
Telephone Number	:	617-906-6176
Fax Number	:	617-906-6177

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

Provider Enumeration Date	:	08/07/2019
Last Update Date	:	03/02/2020

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Directions to “ RUN FENG LICSW” Practice Location

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