Provider Demographics
NPI:1720005739
Name:MEDWID, DARIA J (LICSW)
Entity Type:Individual
Prefix:
First Name:DARIA
Middle Name:J
Last Name:MEDWID
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5617
Mailing Address - Country:US
Mailing Address - Phone:781-395-1281
Mailing Address - Fax:
Practice Address - Street 1:38 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1215
Practice Address - Country:US
Practice Address - Phone:617-964-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10234601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical