Provider Demographics
NPI:1205858552
Name:ADELMAN, IRA DAVID (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:IRA
Middle Name:DAVID
Last Name:ADELMAN
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1617
Mailing Address - Country:US
Mailing Address - Phone:781-662-3223
Mailing Address - Fax:617-527-7557
Practice Address - Street 1:73 UNION ST # 4
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2224
Practice Address - Country:US
Practice Address - Phone:781-662-3223
Practice Address - Fax:617-527-7557
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1065461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04196OtherBC/BS
MAP04196OtherBC/BS