1568452480 NPI number — MR. JOSEPH ROBERT WINN MSW

Table of content: MR. JOSEPH ROBERT WINN MSW (NPI 1568452480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568452480 NPI number — MR. JOSEPH ROBERT WINN MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINN
Provider First Name:
JOSEPH
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568452480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 WALTHAM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYNARD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01754-2411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-897-4242
Provider Business Mailing Address Fax Number:
978-897-4713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 MASSACHUSETTS AVE
Provider Second Line Business Practice Location Address:
SUITE NUMBER 3
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02474-8435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-461-8479
Provider Business Practice Location Address Fax Number:
978-897-4713
Provider Enumeration Date:
10/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1028690 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1852957 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7052259 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P08030 . This is a "BLUE CROSS BLUE SHIELD MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P08030 . This is a "PERSONAL HELP CONNECTION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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