Provider Demographics
NPI:1821975624
Name:DEWALT, AVERY SIMONE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:SIMONE
Last Name:DEWALT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 CHERRY TREE DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-8241
Mailing Address - Country:US
Mailing Address - Phone:817-889-4232
Mailing Address - Fax:
Practice Address - Street 1:851 MAIN ST STE 24
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1614
Practice Address - Country:US
Practice Address - Phone:781-817-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW2140934104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker