Provider Demographics
NPI:1598797128
Name:DUGAN, JOHN H (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:H
Last Name:DUGAN
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 1:64 CHURCH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-3730
Mailing Address - Country:US
Mailing Address - Phone:617-504-6444
Mailing Address - Fax:617-441-7510
Practice Address - Street 1:64 CHURCH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3730
Practice Address - Country:US
Practice Address - Phone:617-504-6444
Practice Address - Fax:617-441-7510
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1108881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07959OtherBCBS
MAP22638Medicare ID - Type Unspecified