Provider Demographics
NPI:1144395740
Name:PIC, JOAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:PIC
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 1:8 MINER STREET
Mailing Address - Street 2:APT 2
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-3609
Mailing Address - Country:US
Mailing Address - Phone:617-625-1761
Mailing Address - Fax:
Practice Address - Street 1:169 ELM STREET
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5356
Practice Address - Country:US
Practice Address - Phone:781-894-8440
Practice Address - Fax:781-894-1202
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10162721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303287OtherMBHP
MA1303287Medicaid
703136OtherTUFTS
1004745OtherNHP
MAP10329OtherBCBS
NP10332OtherBOSTON MED CTR
99618201OtherNETWORK HEALTH
MAM18633OtherBCBS
99618201OtherNETWORK HEALTH
MAP10329OtherBCBS