1215008321 NPI number — MR. SEWARD THOMAS HUNTER MSW, LICSW

Table of content: MR. SEWARD THOMAS HUNTER MSW, LICSW (NPI 1215008321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215008321 NPI number — MR. SEWARD THOMAS HUNTER MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNTER
Provider First Name:
SEWARD
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
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:
1215008321
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:
122 ORCHARD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02144-3020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-628-3163
Provider Business Mailing Address Fax Number:
617-776-0994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1105 MASSACHUSETTS AVE
Provider Second Line Business Practice Location Address:
SUITE 1G
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-628-3163
Provider Business Practice Location Address Fax Number:
617-776-0994
Provider Enumeration Date:
11/11/2006

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:  1020699 , 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: P08367 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 85126 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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