Provider Demographics
NPI:1952913121
Name:PRATT, VIRGINIA DAWN (LCSW)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:DAWN
Last Name:PRATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 AMORY STREET
Mailing Address - Street 2:ETHOS/EMHOT
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:617-477-6919
Mailing Address - Fax:617-524-2899
Practice Address - Street 1:ETHOS
Practice Address - Street 2:555 AMORY STREET
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-522-6700
Practice Address - Fax:617-524-2899
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215729104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker