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NPI Code Detail

MEDICARE: WALTER SHERBURNE LICSW

MEDICARE: WALTER SHERBURNE 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 Worker107185MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1107185OTHERMALICSW MA LIC#

General Provider Information

NPI Number : 1881896298
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALTER SHERBURNE LICSW
Provider Business Mailing Address
First Line : 103 RONALD RD
Second Line :
City : ARLINGTON
State : MA
Zip : 02474-2050
Country : US
Telephone Number : 617-797-8739
Fax Number :
Provider Business Practice Location Address
First Line : 142 NORTH RD
Second Line : F-105
City : SUDBURY
State : MA
Zip : 01776-1142
Country : US
Telephone Number : 978-287-0810
Fax Number : 978-287-5566
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2007
Last Update Date : 07/08/2007

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Directions to “ WALTER SHERBURNE LICSW” Practice Location

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