Provider Demographics
NPI:1629553367
Name:LICHTEN, JOHN (LICSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LICHTEN
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 1:7 WALDINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2732
Mailing Address - Country:US
Mailing Address - Phone:617-792-8101
Mailing Address - Fax:
Practice Address - Street 1:7 WALDINGFIELD RD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2732
Practice Address - Country:US
Practice Address - Phone:617-792-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103901-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical