Provider Demographics
NPI:1215108238
Name:AN, DANA G (LCSW)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:G
Last Name:AN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:L
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:133 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-421-1157
Mailing Address - Fax:617-421-6116
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-421-1157
Practice Address - Fax:617-421-6116
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1158511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical