1427213990 NPI number — MS. MING WEI NAGASAWA LICSW

Table of content: MS. MING WEI NAGASAWA LICSW (NPI 1427213990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427213990 NPI number — MS. MING WEI NAGASAWA LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAGASAWA
Provider First Name:
MING
Provider Middle Name:
WEI
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

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:
1427213990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91 NIGHTINGALE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORCHESTER CENTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02124-1705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-850-2512
Provider Business Mailing Address Fax Number:
617-229-6299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02445-6874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-850-2512
Provider Business Practice Location Address Fax Number:
617-229-6299
Provider Enumeration Date:
07/24/2008

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0023801 . This is a "MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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