Provider Demographics
NPI:1790129336
Name:SUBEDI, SUBRATH (LICSW)
Entity Type:Individual
Prefix:
First Name:SUBRATH
Middle Name:
Last Name:SUBEDI
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 1:305 BELMONT ST
Mailing Address - Street 2:DEPARTMENT OF MENTAL HEALTH - CENTRAL WEST AREA
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1681
Mailing Address - Country:US
Mailing Address - Phone:401-949-4024
Mailing Address - Fax:
Practice Address - Street 1:305 BELMONT ST
Practice Address - Street 2:DEPARTMENT OF MENTAL HEALTH - CENTRAL WEST AREA
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1681
Practice Address - Country:US
Practice Address - Phone:401-949-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW016561041C0700X
MA1134751041C0700X
CT0082231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical