Provider Demographics
NPI:1427213990
Name:NAGASAWA, MING WEI (LICSW)
Entity type:Individual
Prefix:MS
First Name:MING
Middle Name:WEI
Last Name:NAGASAWA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 NIGHTINGALE ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-1705
Mailing Address - Country:US
Mailing Address - Phone:617-850-2512
Mailing Address - Fax:617-229-6299
Practice Address - Street 1:370 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6874
Practice Address - Country:US
Practice Address - Phone:617-850-2512
Practice Address - Fax:617-229-6299
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0023801OtherMEDICARE