Provider Demographics
NPI:1083761233
Name:OSHIRO, DANA JILL (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:JILL
Last Name:OSHIRO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1007
Mailing Address - Country:US
Mailing Address - Phone:781-862-0838
Mailing Address - Fax:
Practice Address - Street 1:57 BEDFORD ST
Practice Address - Street 2:SUITE 125
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4500
Practice Address - Country:US
Practice Address - Phone:781-248-9662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10238371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07558OtherBLUE CROSS BLUE SHIELD
MAP20161Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER