Provider Demographics
NPI:1407051600
Name:SCIRETTA, JOHN N (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:N
Last Name:SCIRETTA
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:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02456-0552
Mailing Address - Country:US
Mailing Address - Phone:617-527-6675
Mailing Address - Fax:617-492-0538
Practice Address - Street 1:217 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1334
Practice Address - Country:US
Practice Address - Phone:617-526-6675
Practice Address - Fax:617-492-0538
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA035038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA403253OtherTUFTS
MAP)4222OtherBLUE CROSS
MA403253OtherTUFTS