Provider Demographics
NPI:1225164940
Name:COUNTS, DOUGLAS W (LICSW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:COUNTS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2143
Mailing Address - Country:US
Mailing Address - Phone:508-438-0160
Mailing Address - Fax:508-831-9967
Practice Address - Street 1:338 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2143
Practice Address - Country:US
Practice Address - Phone:508-438-0160
Practice Address - Fax:508-831-9967
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10197521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06884Medicare ID - Type Unspecified