Provider Demographics
NPI:1649007121
Name:JOSEPHSON, LOUIS CHARLES (LCSW)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:CHARLES
Last Name:JOSEPHSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NEWMAN PL
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-3508
Mailing Address - Country:US
Mailing Address - Phone:802-689-0067
Mailing Address - Fax:
Practice Address - Street 1:4 NEWMAN PL
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-3508
Practice Address - Country:US
Practice Address - Phone:802-689-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038961-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty