MEDICARE: MR. PHILIP R. DECTER MSW, 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	1031020	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	:	1891822169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP R. DECTER MSW, LICSW

Provider Business Mailing Address
First Line	:	59 BOYLSTON ST # 3
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-4424
Country	:	US
Telephone Number	:	617-413-0447
Fax Number	:	617-924-5111

Provider Business Practice Location Address
First Line	:	51 KONDAZIAN ST
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-2830
Country	:	US
Telephone Number	:	617-413-0447
Fax Number	:	617-924-5111

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/09/2007

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Directions to “ MR. PHILIP R. DECTER MSW, LICSW” Practice Location

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