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Organization
MARK DEYAB LICSW INC
Active
Organization
MARK DEYAB LICSW INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK DEYAB LICSW (PSYCHOTHERAPIST)
(781) 799-3949
Entity
Organization
Contact information
Practice address
1 W FOSTER ST, 3RD FLOOR, MELROSE, MA 02176-3847
(781) 799-3949
(781) 665-0027
Mailing address
34 WAREHAM ST, APT. 1, MEDFORD, MA 02155-6222
(781) 799-3949
(781) 665-0027
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
111824
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104907732
NPI
MA
Enumeration date
08/21/2013
Last updated
08/21/2013
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