Provider Demographics
NPI:1598813784
Name:LENNON, DAVID JOHN SR (LICSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:LENNON
Suffix:SR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BURLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3996
Mailing Address - Country:US
Mailing Address - Phone:781-933-2040
Mailing Address - Fax:
Practice Address - Street 1:620 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2900
Practice Address - Country:US
Practice Address - Phone:781-933-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10268541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22153Medicare ID - Type UnspecifiedMEDICARE PART B