Provider Demographics
NPI:1578679189
Name:SCHIFF, JONATHAN A (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:A
Last Name:SCHIFF
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 1:1577 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4602
Mailing Address - Country:US
Mailing Address - Phone:617-899-4905
Mailing Address - Fax:
Practice Address - Street 1:723 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2318
Practice Address - Country:US
Practice Address - Phone:617-534-4212
Practice Address - Fax:617-534-4221
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1152181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1306421Medicaid
MA1308785OtherMCD SA BCBS MH M18684
MA2220002001OtherBCBS OH
MA1306421Medicaid