Provider Demographics
NPI:1144717711
Name:BETH ISRAEL DEACONESS HEALTHCARE
Entity type:Organization
Organization Name:BETH ISRAEL DEACONESS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:SHARAF
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-754-0549
Mailing Address - Street 1:464 HILLSIDE AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494
Mailing Address - Country:US
Mailing Address - Phone:617-754-0549
Mailing Address - Fax:617-754-0701
Practice Address - Street 1:464 HILLSIDE AVENUE
Practice Address - Street 2:SUITE 304
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494
Practice Address - Country:US
Practice Address - Phone:617-754-0549
Practice Address - Fax:617-754-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158258207R00000X
MA72667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty