Provider Demographics
NPI:1699888479
Name:DIREDA, JAMES S (LICSW, PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:DIREDA
Suffix:
Gender:M
Credentials:LICSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LESLEY LN
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MA
Mailing Address - Zip Code:01564-2364
Mailing Address - Country:US
Mailing Address - Phone:508-361-4258
Mailing Address - Fax:
Practice Address - Street 1:78 BURNCOAT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1331
Practice Address - Country:US
Practice Address - Phone:508-361-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW1029269-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08350OtherBCBS OF MA
MAP08350OtherBCBS OF MA