Provider Demographics
NPI:1518273705
Name:DWYER, JODI C (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:C
Last Name:DWYER
Suffix:
Gender:F
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 1:84 HIGH STREET
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155
Mailing Address - Country:US
Mailing Address - Phone:781-350-4430
Mailing Address - Fax:
Practice Address - Street 1:84 HIGH STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:781-350-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2016-01-14
Deactivation Date:2013-10-10
Deactivation Code:
Reactivation Date:2016-01-14
Provider Licenses
StateLicense IDTaxonomies
MA6347451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical