Provider Demographics
NPI:1437264249
Name:MONGEON, DEBORAH A (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:MONGEON
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 1:2311 JEFFERSON PL
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-6301
Mailing Address - Country:US
Mailing Address - Phone:508-657-1824
Mailing Address - Fax:
Practice Address - Street 1:105 PINE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5355
Practice Address - Country:US
Practice Address - Phone:781-893-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10320761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical