Provider Demographics
NPI:1477033470
Name:BARSOOK, HOWARD JAY X (SMW, LCISW)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:JAY
Last Name:BARSOOK
Suffix:X
Gender:M
Credentials:SMW, LCISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DIMOCK ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1210
Mailing Address - Country:US
Mailing Address - Phone:617-989-2800
Mailing Address - Fax:
Practice Address - Street 1:7 COMMONWEALTH CT APT 15
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-4525
Practice Address - Country:US
Practice Address - Phone:617-232-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10206291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical